Foetal alcohol spectrum disorder (FASD) is a lifelong condition where diffuse brain injury is caused by antenatal alcohol use. It is thought that the prevalence of foetal alcohol spectrum disorder may be as high of 2 - 4% of the Australian population. The majority of people with the disorder have not been diagnosed. They are, however, accessing their GP regularly as well as seeing other health professionals due to their multiple difficulties. The Australian diagnostic criteria for FASD are now available online.
GPs should consider FASD particularly in children, young people and young adults who have difficulties in multiple areas. People with FASD present with learning and language difficulties and they may have a present or past diagnosis of ADHD and/or Autism.
Depending on their age they are likely to have mental health conditions including depression and anxiety. There is a high risk of drug and alcohol use later in life as well as incarceration. The three sentinel facial features only occur in 15-20% of those with FASD. Growth retardation is now no longer in the diagnostic criteria but is noted as a possible effect of alcohol in pregnancy.
The initial part of the diagnostic criteria relies on there being a history of alcohol use in pregnancy. This history can be difficult to obtain. It is often difficult for mothers to answer questions about alcohol in pregnancy. A suggested way to ask is to first inquire about what gestation did they find out they were pregnant (current statistics indicate that 50% of pregnancies in Australia are unplanned ).
If the pregnancy was unplanned and some time elapsed from conception through to finding out they were pregnant then the clinician can ask “ were there any lifestyle changes you made when you found out you were pregnant “ or “did you cut down on your smoking and drinking when you found out you were pregnant?”.
We cannot fix the brain of a person with FASD… most useful is having an “external brain”
It may well be that questions around alcohol in pregnancy need to be asked at different times over several years to get a candid response. Recording of alcohol use in pregnancy is vital and is something we could do better.
At this stage we do not think any level of alcohol consumption during pregnancy is safe and so the recommendation should be nil consumption, even if not every mother who drinks alcohol in pregnancy will have a baby that is affected.
The risks increase with high risk drinking i.e. binge drinking and drinking in the first trimester. If a pregnancy and the subsequent baby is felt to be at risk of FASD then this should be recorded in the notes. This child should have an increased level of growth and developmental monitoring and be referred for allied health assessment and support +/- a paediatrician if there are concerns.
Diagnosing adults that may have FASD is possibly more difficult. Assessments by a neuropsychologist can aid in the diagnosis. Assessments may also be possible in some areas in the future. A diagnosis of FASD may be able to help a young person or adult accessing the NDIS and hence access support. It can also be important in the justice system where there has been an increased level of education and some FASD assessments occurring, especially in other states.
While we cannot fix the brain of a person with FASD we can help them to function at their best. The strategy that is most useful is if they can have an “external brain”. This means having another person supervising them, helping them with decision making and supporting them in their areas of difficulty, i.e. having a carer and other supports. Sometimes medication for ADHD can be helpful in reducing the ADHD symptoms if they are present.
Prevention of FASD is vital. Contraception is obviously a crucial part of this in that the majority of pregnancies where FASD ensues are not planned. Education is the key. While there is education provided in schools around this issue, repeated reminders when a young female is accessing a general practitioner is vital.
Prevention and support for those with FASD needs to come from health professionals as well as the entire community. Together we can make a difference.