August 6 2018

20 myths about fetal alcohol spectrum debunked

Carmela Pestell
By Clinical neuropsychologist

Watch the full video

What I’ll be doing tonight is hopefully dispelling the top 20 myths related to FASD as I’ve come across them in the last few years working in this area. The main themes I’ll be focusing on are the prevalent diagnostic issues related to fetal alcohol, spectrum disorder, some information about the drinking guidelines, and why drinking is particularly harmful to the developing fetus. How we diagnose FASD, and the symptoms of FASD and what we can do about it. Of course, my present notes have disappeared off the screen, but that’s okay, because there’s just one little bit I want to read to you right at the beginning.

It’s likely that the possible dangers of drinking in pregnancy have been suspected for many years, as there is even a quote in the Bible which says, “Behold, thou shall conceive and bear a son, and now drink no wine or strong drink.” And that was in Judges 13:7. In 1726, the Royal College of [inaudible 00:12:59] Decisions started a petition asking the government to place restrictions on alcohol consumption and cold gin that cause weak feeble and distempered children.

It wasn’t until 1973, that a couple of researchers, Jones and Smith coined the term Fetal Alcohol Syndrome to describe a group of children born to alcoholic mothers. They had very distinctive facial features and poor prenatal, postnatal growth and who later developed problems with learning. By 2000, it was recognized that alcohol exposure in utero may result in neuro developmental problems, and so the term FASD was coined. You can see from this picture there’s a little child being held upside down and probably can’t see very well, but he does have the classic dysmorphic facial features of FASD, and I’ll talk about those in a moment. We’ve known that alcohol for a very long time causes problems, and one of the common myths we come across is the belief that it’s only a problem in indigenous communities around the world. That’s just simply not the case. Well, it’s a problem in those communities, and there’s been a lot of research and focus on those groups. It’s a problem that affects all sectors of society. Within Australia, one prevalent study which captured reporting by pediatricians found a prevalence of about .06 per 1000 live births. And I think that’s likely to be an underestimate. I’ll talk about the reasons why in a moment. James Fitzpatrick, PhD, looking at the little one project actually found much higher rates in the Fitzroy Valley, so 120 per 1000 in seven to nine year olds.

There’s also data that shows that alcohol related birth defects around the pool prevalence of 10.2 per 1000. It’s a huge problem. FASD probably occurs in around one to five out of 1000 births around the world. You can see here a diagram that shows the percentages of women that drink during pregnancy among the general population. The countries in blue, particularly the very dark blue, like Russia have very high rates. And you can see there’s also very high rates in South Africa as well. Australia is up there too. A recent US study also found that the prevalence rates are much higher, about 11.3 to 50 per 1000. That means that there’s probably around 1.2 million people in Australia currently affected by FASD, and that’s an underestimate.

It’s also often thought that FASD only affects women from low socio-economic backgrounds. We know that’s not the case. We know that around 60% of women in Australia drink during pregnancy. Half of those, 30% do stop, when they realize that they’re pregnant, but the rest continue to drink throughout their pregnancy. Women from middle to higher socio-economic groups tend to actually … There’s a high proportion of those women that continue to drink, it’s just that those from low socio-economic groups tend to drink a bit more. The percentage is still up there, and what’s really concerning, is that it’s estimated that about 50% of women don’t realize that they’re pregnant. And so many women continue and it did happen to me, and my daughter knows that, they don’t realize that they’re pregnant, and they might go to a party and have a few drinks. That’s really quite common.

The other problem is a lot of women will occasionally have a binge drink. We know that binge drinking is particularly toxic to the developing fetus. There is data that shows that women from middle to high economic groups do drink quite a lot within Australia. This was a table taken from a study back in 2010, and as you can see, the middle and highest income families, 38% from the middle sector drank during pregnancy and 51, nearly 52% in the high sector. I think these women can afford alcohol, and there’s something about Australian culture, I think, we do have an unhealthy relationship with alcohol. That tension between probably known for very long time that alcohol is not great for the baby and yet we still for many different reasons continue to drink during pregnancy, and so that message isn’t getting across.

Another myth is that FASD really goes undiagnosed. We know those diagnosed are the tip of the iceberg, and this is because there’s an absence of routine screening. Health professionals typically don’t ask women whether they drink during pregnancy. It’s an uncomfortable topic, it’s a confronting topic at times, particularly if the health professional themselves is drunk during pregnancy, or their friends have, or other family members have. And so there’s a tendency to sweep it under the carpet. That’s the sound of my alarm, and I suddenly thought, “Oh, my goodness. I was supposed to be somewhere.” It’s swept under the carpet. There’s a lot of shame and stigma around drinking during pregnancy, and the only way we can overcome that stigma is by having these two types of talks and actually having those difficult conversations with our family and friends, but also our clients.

There’s a lack of confidence and awareness about the Australian diagnostic guidelines or other international diagnostic guidelines that we have, and I’m going to cover those in a moment. There is also a lack of diagnostic services. There’s a few clinics and teams around Australia who are working and doing fantastic work in this area, but we know that clinicians generally lack confidence. I was in Darwin last week talking to a group of psychologists, school psychologists, and they were saying that part of the problem for them is that the services are just so splintered. So even if they can do one part of the assessment, because a multidisciplinary assessment is recommended, and it’s a bit like the assessment we do for autism, then it becomes really problematic, and it becomes really fragmented, and services don’t talk to each other.

There’s also because you don’t need the fetal features to have FASD. That’s another problem and another myth that I’m going to go through in a moment. That means a lot of children go unnoticed, and they’re sitting in our classrooms with learning and other types of thinking problems, and no one actually joins the dots and realizes that it’s probably because their mother drank alcohol during pregnancy. The main myth, I think, is that it’s safe to drink alcohol during pregnancy, and the fact is that researchers really don’t know what a safe level is. The recommendations are that no drinking is safe during pregnancy, that alcohol affects the growing fetus throughout the whole development, and its impacts has an adverse effect on the nervous system, and I’m going to talk about that in a moment.

There’s a myth that it’s okay to drink alcohol after the first trimester. But like I said, alcohol continues to affect the baby or the growing fetus right the way through. As you can see from this chart, which shows the developing baby’s vulnerability to alcohol related defects during specific periods of development. If you look at the top brow, you’ll see that the central nervous system is developing from week three, right the way through to week 38. And sure, if a woman drinks during the second and third week of the pregnancy, you’ll get those dysmorphic facial features. But if they drink from week four right the way through week 38, they’re not going to get the facial features, but they’re potentially going to have a child with FASD.

The other thing to emphasize too is just because a woman had a few drinks during pregnancy doesn’t necessarily mean that they’re going to have a child with FASD. We really don’t know why it is that some women are more vulnerable to the effects of alcohol than others. And some of the ideas around that are possibly that it’s because the woman might have poor nutrition or be highly stressed, and we know that cortisol can affect the growing fetus, particularly if there’s significant levels of trauma and other adverse events, or they could be genetic vulnerabilities, and so on, that we really don’t know. It really is like playing Lotto. You don’t know where you go get lucky and not have a child that’s affected. The guidelines really are, it’s probably better off just not taking that risk.

These guidelines have been adopted within Australia and also by the Australian Medical Association, who promote the notion or the guideline that maternal alcohol consumption can harm the developing fetus or breastfeeding baby. I feel women who are pregnant or planning a pregnancy, not drinking is the safest option, and that’s also the case for women who are breastfeeding. But I know myself when I had a baby. What did everyone do? My family and friends got me bottles of champagne. And that’s really common. We have to be thinking about our role as well in supporting women not to drink during that time.

Another myth is that only children of women who are alcoholics, or very heavy drinkers, who have children with FASD, and that’s not the case either. In fact, I’ve even had people say to me, “Oh, I thought because I was not an alcoholic, but I drank regularly, I had built up quite a tolerance to alcohol that I was passing on that tolerance to the growing baby, and it would be okay.” There’s lots of misinformation and one of the problems is there’s lots of confusing messages out there, for example, on the internet, and so on.

Then another myth is that the placenta then filters out harmful substances. We know that’s simply not the case. In fact, the growing baby is actually more at risk of the effects of alcohol, so they can be exposed to high levels and for longer got as well. Alcohol is incredibly toxic to the growing fetus, and there’s been over 4000 studies, at least, which is documented how dangerous alcohol is. In fact, the Institute of Medicine made it very clear that of all the substances of dependence including cocaine, heroin, and marijuana, alcohol produces by far the most serious neurobehavioral effects in the fetus. This is because alcohol causes a whole host of different problems, and I’m not going to go through all of them tonight, but they include things like it actually kills brain cells, it reduces their growth, it causes what we describe as migrational areas and brain development. By that I mean that certain cells are supposed to develop in one part of the brain, but they actually pop up in other parts of the brain.

There’s also an inhibition of nerve growth factor and it disrupts neurotransmitters. That means that these children are more at risk of problems with regulating their emotions, they’re more at risky problems with depression and anxiety, and also it disrupts their sleep as well. There are some seats down here if you’re uncomfortable on the stair. Are you all right? Okay.

Another myth is that some types of alcohol are safer than others, and again, that’s not the case. If you’re pregnant and you’re drinking beer instead of spirits, thinking that you’re actually doing the right thing, that’s actually, it’s not the case. That one standard drink is 10 grams of alcohol. It’s a standard drink regardless of what … Sorry. Regardless of what has been drunk.

Another myth is that it’s the mother’s fault. I can’t emphasize enough how important it is for us to move away from the idea that it’s just as simple as that. The situation is a lot more complex. Women drink for a whole host of different reasons. Addiction is a huge issue for a lot of women, and so if they go and see a GP, and the GP says, “Oh, you’ve got to stop drinking during pregnancy.” We all know if you think about our own struggles with coffee addiction or whatever, and nicotine or whatever. We know that it’s actually really hard to give up drinking alcohol. Women need support, they need access to resources like psychologists and other people that can actually help them with their addiction. Even if it means reducing the amount that they’re drinking during pregnancy, that’s really important.

We also know that women can be under a lot of stress. They might be psychosocial stresses, they might be under pressure from the partner who is a heavy drinker to drink as well, or they might have been misinformed or not given the right information about the drinking issue, or they maybe have even been told by their doctor that it’s okay to drink. I think it’s important, as I said earlier, for us to try and overcome the shame and stigma around this condition by having those conversations in a really non judgmental way and not blaming the mother. Because if we do that, they will be more likely to come forward and talk about it. Community initiatives like this one, which was on the Pregnant Pause Initiative, which was around making the pledge to go alcohol free during your pregnancy, or the pregnancy of a loved one, is a really nice initiative. It’s a way of supporting women not to drink. Kathleen Mitchell, Vice President of the NOFAS Association in the States makes a really important point. This is her picture here with her biological daughter who has FASD. “In over 20 years of working on FASD prevention, I have never met a mom who intentionally wanted to harm her unborn baby. Either she didn’t know the alcohol was harmed during pregnancy, or she needed help to stop drinking.”

Another myth, and this is a nice picture of [inaudible 00:31:11], who I know is in the audience, but I don’t know where she is. She is our pediatrician. One of our pediatricians. Is that children grow out of FASD. FASD is a lifelong disability. It’s caused by the brain impairments that are the pathological process of alcohol affecting the brain, and so it’s something that that person will always have. It doesn’t necessarily mean that they can overcome some of the challenges associated with it, and it’s a spectrum disorder, so we know that some people are going to be affected more than others, but that child is going to have problems their entire life. At the moment, I’m not convinced that our funding bodies necessarily understand that, and so we need to do more about advocating that these individuals get the support that they need.

As I mentioned earlier, there’s also a myth that all children with FASD will have unusual facial features and look different. The three typical dysmorphic facial features are the thin upper lip, the smooth philtrum, which is the groove above the lip, and also the space between the eyes called the palpebral fissure length. It’s not uncommon for people to have one of these or two of these features, so don’t panic if you suddenly realize your husband has a thin upper lip. You might offend them if you suggest they have FASD. But we know in our own research at Patches, that around 20% of the children we’ve diagnosed with FASD actually do have the three facial features. But this 80% that don’t, and that’s out of 220 of all the kids that we’ve given that diagnosis.

One of the other problems is because it’s not a disability that you can physically see. Many of these children look neurotypical. It is often overlooked, and this is why it’s called invisible disability. A young boy I was working with captured this really well by saying, “Because they can’t see my brain, I feel they can’t see I have a disability. I have no scars, I don’t limp. I look normal. But I have all these problems with my thinking and the way I act.” It’s really important that we help children understand why it is they’re having the difficulties that they’re having. But of course, that’s difficult, because it does mean that they have to face such repercussions within the family system.

Another myth is that because there is no cure, there is no point giving a diagnosis. We know that there’s so many different treatment options and other things that we can do to help these individuals and this is captured really well. I’m just going to pull up a video now by a young man with FASD. He talks about the importance of FASD diagnosis behavior. It’s just a three to so minutes video, but I think it’s really important to highlight.

It’s been a common problem in our travels around Australia trying to teach people how to diagnose FASD. There’s been a real reluctance for a whole range of reasons, and hopefully you can see with the video from [Myles 00:35:26], some of the important reasons why it’s important. But I also think it’s important because it helps young people to make a sense of themselves. It reduces the impact of cognitive and educational difficulties, it reduces children’s involvement with the justice system, because we know kids with FASD have much higher rates of becoming involved with Corrective Services. In fact, the average age that they get involved is about 12 years. I’m going to talk more about that in a moment. It also reduces the impact of the common comorbidities that can occur in FASD because these children are at risk of a range of different medical and neuropsychological conditions. And by knowing I have FASD, it means that we can properly assess and diagnose them and monitor them for that. It also creates a paradigm shift in attitudes. People view a child with FASD very differently if they know there’s this brain based problem that’s contributing to their challenging behaviors. And hopefully will also open the doors for services and treatment.

As a 15 year old boy with FASD said, he was part of our Banksia Hill Detention Center prevalence project of … Oh, thank God … This is what he said after a feedback session. “Oh, Thank God. That means I’m not the problem, I have a problem. I can deal with that.” I believe people have the right to know if that’s the condition and we shouldn’t be pretending that it’s not. We shouldn’t be diagnosing FASD because of the stigma and concerns about the repercussions for the family. And yet we come across that view time and time again, when we travel around Australia, China, encourage clinicians to use the new diagnostic guidelines.

Anne Russell, who is a mother herself with two children that have FASD and she’s written this excellent book, which I’m reading at the moment, Alcohol And Pregnancy, says that, “I think if we do that, the child is sacrificed so that the mom does not have to bear any guilt. We don’t do that with any other disability in the world. We are throwing away any chance the child might have for a better life we when do that. People have no idea what they are sentencing the child to, when doctors choose this route. To make a choice to condemn a child to a life where he or she has a significant invisible disability with no one to turn to, no support, no understanding that he or she has a disability, no friends who understand. I don’t imagine any mother would want that for a child if she had the choice.”

Okay. I’ll go to this myth now. Another myth that I’ve come across is that they are no diagnostic guidelines in Australia. In fact, James and I sat in a conference last year where somebody was giving a presentation about FASD in the diagnostic guidelines, and not even referring … This was in Perth. Not even referring to the Australian diagnostic guidelines, but talking about the American ones. We do have diagnostic guidelines. They were produced in May 2016, and I believe that any health professional working in Australia needs to know what they are and be adopting those guidelines. And this is recognized by the Commonwealth government, who recently allocated several million dollars with a funding so that clinicians can start to learn and become more confident in learning how to diagnose FASD. We’ve been lucky enough at Patches, and this has been led by James Fitzpatrick to deliver this project. Our manager, Anne Hawkins, is sitting on a step up there, I think, to try and spread the word. THis is a three project, and it also involves the UWA graduate certificate in FASD diagnosis.

What are the diagnostic guidelines? I don’t have time to go into them in a lot of depth, you can download them at the link above here, which is also on the FASD hub website. Basically, they’re based on the Canadian guidelines, and they have been simplified so that you can either have FASD with three sentinel facial features. If a child has three facial features, you don’t need confirmation that the mom drank during pregnancy as it’s highly likely that she did and that this is FASD. Although, in addition to that you do need evidence of impairment in three or more neurodevelopmental domains. I’ll describe what those domains are in a moment. All the infants and young children, if their children are very small, that needs to be evidence of a smaller head conference. Or you can have FASD without sentinel facial features. That means no facial features, one facial feature or two. And there also needs to be confirmation that mom drank at a level that’s estimated to be a toxic dose and associated with neurodevelopmental effects. And we know that the more the mother drinks, that’s likely to be the case.

The FASD diagnosis, there’s 10 neurodevelopmental domains that we look at. The first one is whether there is severe impairment in brain structural neurology, and that includes, as I’ve just mentioned, the abnormal head circumference, whether there’s brain abnormalities that shown on imaging, a seizure disorder, or significant neurological diagnoses that can’t be explained by a head injury or something like that. But you don’t necessarily have to have those difficulties, because a child might have three difficulties in three or more of these domains that I’ve got listed here. Impairment is defined under the Australian guidelines as the child doing worse than 97% of the children their age. We ascertain that by giving tests like neuropsychological tests to determine where the child is in relation to other children their age, and a whole different range of different types of skills and abilities. We found in our own research at Patches that the majority of these children do have quite significant executive functioning and impulse control and hyperactivity problems. They also have difficulties with attention, academic achievement, both expressive and receptive language problems, adaptive behavior so their daily living skills and so on, social skills, social communication, memory, their thinking and IQ, their ability to regulate their emotions, and their mental skills.

As I said before, children with FASD, there’s a myth that children with FASD are naughty or lazy. I think that happens because people aren’t realizing that those neurodevelopmental domains are impaired or an understanding why the child is having the problem they are, or they’re not really picking up on the different types of comorbidities that can occur with FASD. And with our own cohort, we’ll be presenting this data in a lot more detail in the next FASD National Conference, which is in Perth in November. But just as a quick snapshot, we know that a high proportion of these children are going to have co-morbid conditions like language disorders, ADHD, sleep disturbance, mood problems. About a third will have intellectual disability. They’re also at risk of hearing problems, specific learning disabilities, visual impairments, conduct disorders, and oppositional defiant disorders. And you can see the percentages they’re based on our own cohort from WA in Northern territory, and I think it ranges somewhere between 2 and 31 years of age.

These individuals are also at a much higher risk of suicide. They’re really vulnerable, and those with FASD demonstrate characteristics of features that are commonly thought to be respected for suicide. They’re more likely to be at risk of mental illness, they’re more likely to develop problems with alcohol and substance abuse themselves, more likely to be impulsive. In many ways, it’s that perfect storm. We have all those Neuro psychological difficulties, all those problems with ethic regulation. They’re misunderstood. People aren’t understanding or understanding the reasons why they’re having the problems they are, and so they are much more likely to have suicidal behaviors.

One of the problems with these kids too is that they have quite significant social problems, and that’s why they’re often misdiagnosed as having Autism Spectrum Disorder. They can have significant difficulties with social skills, they’re likely to be socially vulnerable, overly trusting and immature, they’re often scapegoated and bullied, and have a lack of self awareness with poor boundaries. They also lack empathy because they don’t show that theory of mind. They have difficulty saying things from another person’s perspective, and that can lead to inappropriate social interactions. It can also lead to problems with interactions with the place and in situations escalating because they’re not understanding the social nuances within a particular interaction.

There’s a myth that all children with FASD have an intellectual disability like my brother here who has Down Syndrome. But as I said earlier, that’s not the case at all. We know that only a third of these kids will have intellectual disability. Having said that, FASD is the leading preventable cause of intellectual disability in the Western world if we think if women didn’t drink during pregnancy, how many millions of children will we be saving from a sentence like this in terms of having a severe intellectual disability with an IQ less than 70.

One of the other complicating factors is that there’s often a discrepancy with children with FASD between the IQ. They might have an average IQ, but they have significant problems with their academic functioning, or their adaptive functioning so they can’t apply their intelligence in a way that means that they can be functional in society. They might have difficulty, for example, coping in an emergency, or they exhibit really poor reasoning and judgment because of the underlying executive functioning problems that they have. There’s not a correlation between the three facial features and the severity of the cognitive impairment. A child can have no facial features, but actually still be very severely affected by the cognitive difficulties that occur in FASD.

There’s also a myth that all individuals with FASD are the same, but that’s actually not the case, and partly it’s because alcohol affects children and the baby differently depending on how much the mother had the dose, the frequency, and the timing, and so on. You get this mixed profile. Each child really needs to be seen and assessed on their own merit because they’re going to have a different level of strengths and weaknesses, and they’re also potentially going to have discrepancies in terms of the actual physical age and how they are. They might be 18 years old, but they could have the comprehension and social maturity of a six year old and the expressive language of a 20 year old. That’s why assessment is so important because we can’t tell how an individual is unless we actually put them through a series of tests and work out what their strengths and weaknesses are.

I’m just going to pick up speed a little bit because I’m aware of the time and that we need to finish by 7:30. These are some of the typical thinking problems that might occur with children with FASD. They have a patchy memory, they’re distractible, they’re concrete thinkers, they can’t abstract or reason in a conceptual way. They have trouble coping with change, they’re impulsive, have poor judgment, and they have difficulty predicting outcomes the same with consequences of their actions.

It’s assessment is really important, and I’ve got here a photo of some of the neuro psychologists that we’ve had the pleasure of working with over the last couple of years, assisting us in the assessment of children with FASD. Assessment is very important for a number of different reasons as I’ve already highlighted. We use the assessment to then guide our intervention and treatment options. It can help tease out those differential diagnosis and comorbidities, we can look and see whether the child actually does have the features that are typical of a person with FASD, we can establish a baseline from which we can monitor their progress.

There’s lots of different treatment options available. Again, I don’t have time to go into all of them, but Dudley and other colleagues at Telethon kids Institute produced a fantastic critical review of the literature where they highlighted some really key points when we’re working with families with FASD. The first one is that a multidisciplinary approach is ideal, with a key worker, that we have to have a systems approach. We have to have a coordinated approach between families, schools, and therapy partnerships. We need to give carers and families access to respond and support. We have to complete these interventions in a culturally safe way, think about their medical needs, and be particularly mindful during their transitions from adolescence into adulthood, another key point in their lives.

We know that cycle education is really important, helping parents understand why it is their children are having the problems that they’re having, and being aware that the interventions are going to change over time and need to be flexible. We also need to focus on that attachment between carers, parents, and their children and look at a strengths-based approach in combining a domain general approach with a domain specific approach. It really needs to be well considered and thought out, and utilizing lots of different strategies, being the child’s frontal lobe for them, teaching new skills and content, teaching strategies that they can apply in real life, learning contexts, and keeping things as predictable as possible. Providing opportunities for guided extended practice, and so on. There’s a lot we can do.

At Patches, we offer the alert program which actually targets emotional regulation in children. We’ve also developed a care support program that focuses on that attachment between children and their parents, or carers, and also incorporates psycho education so that they are understanding the effects that trauma, or maltreatment, or ADHD, or FASD, or any of the other comorbidities that the child might have, and the impact.

This program is turning out to be really successful, and I’ve just included here in our success story. This is a testimonial from a mother in Kununurra, and that’s where I took the photo of the baobab tree. ” I was referred to the Carer Support Program when my 10 year old who is living with FASD and ADHD started to have nuclear tantrums. Through the program, I learned not to see my son’s tantrums as a power struggle between my child and I, but as an opportunity for me to parent. I now use play and curious questioning in conversations with my children every day. The simple phrase is that I [inaudible 00:54:27] to encourage him to think about his behavior, and the act of me applying at consequences through story has helped achieve some wins and behavior change. He feels shame, and there are consequences for acceptable behavior, but we are not ripped apart in the process.

What I particularly love is my 11 year old daughter is now mirroring the curious questioning when she is playing with her brothers.” I thought it was a really nice example of how some of these treatment options can be really successful. Children with FASD are eligible for services through the NDIS, providing this evidence of a functional impairment in certain areas like communication, social interaction, learning mobility, self care, and self management.

It really is a myth that there is no hope for individuals with FASD, even though we do know that many of these people will have adverse long term outcomes, as I’ve mentioned, difficulties with the law, substance abuse, and so on, disrupted education. There’s a lot that we can still do to assist. Although we do have to be mindful that many children and adults sitting in our jails have FASD. That was highlighted by the recent prevalence study that I was privileged enough to be involved in at the Banksia Hill detention center where we found that a third of young people had FASD, and not only that, 9 out of 10 of those kids had some type of severe brain impairment, not necessarily FASD.

We’re failing these children, and we need to as a society, really be thinking about how we can better support them, how they can better recognize their brain impairments, and keep them out of jail to begin with. There is hope. There’s a lot we can do as a community, and I’ve highlighted here some of the things that we can do. We need to continue the excellent prevention efforts that organizations like the Telethon kids Institute have been involved in, we need to improve our diagnosis in multidisciplinary assessment, we need to focus on children in our schools. Because if we can keep them in school away from antisocial peer groups, they’re less likely to get involved in the justice system, they are less likely to develop a whole range of different mood problems, and so on.

We need to provide diversionary programs. I personally believe that every child that comes into contact with Corrective Services should have an assessment and also children in child protection. Because worldwide data shows that about 80% of kids in child protection are likely to have FASD. These kids need improved access to services and improved government recognition so that they can have funding through Medicaid, private health insurance, and so on.

Finally, I believe first is a significant public health issue, but there’s something that all of us can do in this room, because we need to work together to improve awareness and understanding about this condition. If you think that the lifetime cost of an individual with FASD is thought to range between about 2.2 Australian dollars to 3.3 million dollars based on American data, then if we just help prevent one woman from drinking heavily during pregnancy, we’re actually potentially reducing the financial and other non financial cost of this condition, and that money, millions of dollars, can then be channeled into funding therapy and research as well. We can all be first day champions and promote that message in an understanding and non judgmental way.

If you’re interested in further information about FASD, you can go to the FASD Australian hub website which has fantastic resources that’s taken over from the Telethon Kids website to provide this information.