tag:theconversation.com,2011:/fr/topics/fetal-alcohol-spectrum-disorder-21429/articlesFetal Alcohol Spectrum Disorder – The Conversation2023-11-15T13:16:14Ztag:theconversation.com,2011:article/2166012023-11-15T13:16:14Z2023-11-15T13:16:14ZFor decades, mothers have borne the brunt of scrutiny for alcohol use during pregnancy − new research points to dad’s drinking as a significant factor in fetal alcohol syndrome<figure><img src="https://images.theconversation.com/files/558858/original/file-20231110-29-4ks5yo.jpg?ixlib=rb-1.1.0&rect=24%2C36%2C8155%2C5420&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Little to no attention has been given to the father's potential contribution to fetal alcohol syndrome disorders.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/hug-support-and-pregnancy-with-couple-in-living-royalty-free-image/1486895024?phrase=dad+drinking+during+pregnancy&searchscope=image%2Cfilm&adppopup=true">Katleho Seisa/E+ via Getty Images</a></span></figcaption></figure><p>Men drink more, are more likely to binge drink and are almost four times <a href="https://www.cdc.gov/alcohol/fact-sheets/mens-health.htm">more likely to develop alcohol use disorder</a> than women, according to the Centers for Disease Control and Prevention.</p>
<p>Yet when it comes to diagnosing babies born with birth defects associated with alcohol consumption, such as <a href="https://my.clevelandclinic.org/health/diseases/15677-fetal-alcohol-syndrome">fetal alcohol syndrome</a>, historically only the <a href="https://doi.org/10.1542/peds.2015-3113">mother’s drinking habits are taken into consideration</a>.</p>
<p>Research clearly shows that <a href="https://doi.org/10.1016%2Fj.molmet.2018.02.006">sperm carry a vast amount of epigenetic information</a> – meaning heritable shifts in the way genes are expressed that don’t result from changes in the DNA sequence – that strongly influences fetal development and child health. Yet most doctors and other health care providers do not take into account the influence of paternal health and lifestyle choices on child development.</p>
<p>I am <a href="https://scholar.google.com/citations?user=mjARCbsAAAAJ&hl=en">a developmental physiologist</a>, and my research explores the ways that <a href="https://doi.org/10.1002/bdr2.2215">male drinking affects fetal development</a>.</p>
<p>While most of the attention is given to the mom’s drinking while pregnant, my team and I focus on male drinking in the weeks and months before conception. Our studies are the first to demonstrate that male drinking before pregnancy is a <a href="https://doi.org/10.1172/JCI167624">plausible yet completely unexamined factor</a> in the development of alcohol-related craniofacial abnormalities and growth deficiencies. </p>
<h2>The intense focus on mom</h2>
<p>In 1981, the U.S. surgeon general issued a public health warning that <a href="http://come-over.to/FAS/SurgeonGeneral.htm">alcohol use by women during pregnancy</a> was the cause of physical and mental birth defects in children.</p>
<p>This warning came in response to growing recognition that a group of severe physical and mental impairments in children, now commonly known as fetal alcohol syndrome, were <a href="https://pubmed.ncbi.nlm.nih.gov/7250574/">correlated with maternal alcohol use during pregnancy</a>.</p>
<p>Today, doctors and scientists recognize that <a href="https://www.cdc.gov/ncbddd/fasd/1in20.html">as many as 1 in 20 U.S. schoolchildren may exhibit some form</a> of <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-fetal-alcohol-spectrum-disorders#">fetal alcohol spectrum disorders</a>, a term referring to a wide range of <a href="https://www.cdc.gov/ncbddd/fasd/facts.html">alcohol-related physical, developmental and behavioral deficits</a>, many of which cause lifelong challenges for those affected.</p>
<p>According to the CDC, this syndrome can occur when <a href="https://www.cdc.gov/ncbddd/fasd/facts.html">alcohol in the mother’s blood</a> passes to the baby through the umbilical cord. This has led to the firmly <a href="https://www.niaaa.nih.gov/research/fetal-alcohol-spectrum-disorders">accepted</a> belief that alcohol-related birth defects are caused only by maternal alcohol use during pregnancy and are the <a href="https://www.healthychildren.org/English/health-issues/conditions/chronic/Pages/Fetal-Alcohol-Spectrum-Disorders-FAQs-of-Parents-and-Families.aspx">woman’s</a> fault.</p>
<p>The medical community reinforces this perception by requiring pediatricians to compel mothers to confirm and document their prenatal alcohol use before they can formally diagnose children with <a href="https://doi.org/10.1542/peds.2015-3113">alcohol-related birth defects</a> or <a href="https://www.cdc.gov/ncbddd/fasd/features/neurobehavioral-disorder-alcohol.html">neurobehavioral disorders associated with prenatal alcohol exposure</a>. Nonetheless, there are multiple documented instances in which children diagnosed with fetal alcohol syndrome were born to mothers who denied that they consumed alcohol during pregnancy.</p>
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<figcaption><span class="caption">Fetal alcohol syndrome disorder can take a variety of forms. For instance, some may struggle with hand-eye coordination, while others have difficulties with emotional regulation.</span></figcaption>
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<p>For example, in one study, 41 mothers denied having consumed <a href="https://doi.org/10.1016%2Fj.drugalcdep.2022.109351">alcohol during pregnancy</a> despite their child receiving a diagnosis of fetal alcohol syndrome. In this circumstance and <a href="https://doi.org/10.1542/peds.2012-1371">others like it</a> over the past 40 years, the <a href="https://doi.org/10.1542/peds.109.5.815">commonly accepted assumption and explanation</a> is that these mothers lied about their alcohol use during pregnancy.</p>
<p>According to the CDC, there is <a href="https://www.cdc.gov/ncbddd/fasd/alcohol-use.html">no known safe amount of alcohol use</a> during pregnancy or while trying to get pregnant. Despite this recommendation, <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-fetal-alcohol-spectrum-disorders">alcohol use during pregnancy</a> is widely reported.</p>
<p>However, reported drinking levels do not directly correlate with a child developing alcohol-related birth defects, and not all women who drink give birth to children with fetal alcohol syndrome. This contradiction has resulted in <a href="https://doi.org/10.1136%2Fbmj.39371.381308.AD">conflicting</a> public <a href="https://doi.org/10.1136%2Fbmj.39356.489340.AD">messaging</a>.</p>
<p>Although differences in how much and when pregnant women drink can contribute to the variation in how fetal alcohol syndrome develops, these factors alone cannot explain the wide range and severity of symptoms. Therefore, unknown factors beyond maternal alcohol use must contribute to this debilitating disorder.</p>
<h2>Dad is the missing piece</h2>
<p>Alcohol is a social drug, so when women drink, they often do so with their male partner. Building from this perspective, my laboratory used a mouse model to determine <a href="https://doi.org/10.1172/JCI167624">what happens if mom, dad or both parents drink</a>. </p>
<p>Fetal alcohol syndrome is associated with <a href="https://doi.org/10.1542/peds.2015-3113">three core birth defects</a>: facial abnormalities, including small eyes and malformations in the middle of the face; reduced growth of the head and brain; and fetal growth restriction, a condition that occurs when babies are born smaller than average. Building on a previous study in humans, we used facial recognition software to study the effects of alcohol consumption on the faces of mice born to mothers, fathers or both parents who consumed alcohol before conception.</p>
<p>In a study published early this year, we captured a <a href="https://doi.org/10.1172/JCI167624">digital image of the mouse’s face</a>. We then digitally assigned facial landmarks, including specific parts of the eyes, ears, nose and mouth. The computer program then determined if maternal, paternal or dual parental alcohol exposures changed the proportional relationships between each of these landmarks.</p>
<p>Our study using this mouse model revealed that chronic male alcohol exposure affects the <a href="https://doi.org/10.1172/JCI167624">formation of the offspring’s brain, skull and face</a>. We also observed <a href="https://www.cdc.gov/ncbddd/birthdefects/microcephaly.html#">microcephaly</a>, the underdevelopment of the head and brain, as well as lower birth weight, which became worse the more the male parent drank.</p>
<p>Therefore, our studies demonstrate that chronic male alcohol exposure – defined as consuming more than five drinks per day in a four-hour window – could drive all three of the core fetal alcohol syndrome birth defects.</p>
<p>Using this same mouse model, we also determined that these <a href="https://doi.org/10.1172/JCI174216">craniofacial changes persist into later life</a>. Specifically, we identified abnormalities in the jaw and the size and spacing of the adult teeth. Abnormal alignment of the upper and lower teeth is another <a href="https://doi.org/10.1093/alcalc/agy071">recognized symptom of fetal alcohol syndrome in humans</a>.</p>
<p>Besides our research, other studies have identified <a href="https://doi.org/10.1016/j.alcohol.2015.02.008">behavioral changes in the offspring</a> of male mice who regularly consume alcohol. In addition, clinical studies suggest that paternal drinking <a href="https://doi.org/10.1001/jamapediatrics.2021.0291">increases the risk of heart defects</a> in people. </p>
<h2>Effects on male fertility and pregnancy</h2>
<p>Our studies also support more <a href="https://doi.org/10.1093/molehr/gaad002">immediate impacts of alcohol consumption on male fertility</a> and the ability of couples to <a href="https://doi.org/10.3389/fcell.2022.930375">achieve a healthy pregnancy</a>. These observations may be especially relevant for couples struggling to have children.</p>
<p>The CDC estimates that about 2% of all babies born in the U.S. are <a href="https://www.cdc.gov/art/index.html">conceived using assisted reproductive technologies</a>. While the focus of in-vitro fertilization treatments <a href="https://www.cdc.gov/art/ivf-success-estimator/index.html">remains maternal health and lifestyle choices</a>, our studies reveal that male alcohol exposure decreases the chance of becoming pregnant after undergoing IVF.</p>
<p>Significantly, our research showed that the more a man drinks before providing sperm, the <a href="https://doi.org/10.1093/molehr/gaad002">lower the chances of his partner becoming pregnant</a> – in some cases, by almost 50%. </p>
<h2>Looking ahead</h2>
<p>Annual estimates suggest that the cumulative costs of fetal alcohol spectrum disorders to the health care and educational systems range from <a href="https://doi.org/10.1111/add.14841">US$1.29 billion to $10.1 billion annually</a>. Given these exorbitant costs and the devastating lifelong effects on affected individuals, ignoring paternal drinking habits in public health messaging overlooks a significant contributing factor.</p>
<p>The first published investigations into the effects of maternal exposure to toxins on birth defects in the 1950s and ’60s were met with skepticism and disbelief. Today, it is widely accepted that <a href="https://doi.org/10.1542/peds.113.S3.935">maternal exposures to certain drugs</a> cause birth defects.</p>
<p>I fully anticipate that some within the medical and scientific communities, as well as the public, will forcefully deny that paternal drinking matters. However, until doctors start asking the father about his drinking, we will never fully know the contributions of paternal alcohol exposure to birth defects and child health.</p><img src="https://counter.theconversation.com/content/216601/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Golding receives funding from the National Institutes of Health (R01AA028219) and a Medical Research Grant from the W.M. Keck Foundation. </span></em></p>Public health messaging has focused on the drinking habits of the mother during pregnancy. But a growing body of research shows that what dad is drinking before pregnancy matters too.Michael Golding, Professor of Physiology, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1996732023-02-16T01:36:23Z2023-02-16T01:36:23ZFetal alcohol spectrum disorder is tragic but not new. How should fresh funding tackle it in the NT?<figure><img src="https://images.theconversation.com/files/510246/original/file-20230215-16-crz0to.jpg?ixlib=rb-1.1.0&rect=45%2C15%2C5051%2C3400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com.au/detail/photo/pregnant-woman-holding-glass-of-red-wine-royalty-free-image/167457231?phrase=alcohol%20pregnancy&adppopup=true">Getty/Jamie Grill</a></span></figcaption></figure><p>In recent weeks, the Australian and Northern Territory governments <a href="https://theconversation.com/alcohol-bans-return-to-nt-indigenous-communities-with-250-million-federal-assistance-199258">announced</a> new funding to address the longstanding, much-publicised challenges facing Central Australia.</p>
<p>The promised A$250 million adds to an earlier commitment of $48 million and aims to tackle problems faced by residents in Alice Springs and Central Australia from many angles, including strategies to reduce alcohol-related violence, harms and crime. </p>
<p>Included is a <a href="https://cmc.nt.gov.au/news/2023/$298-million-landmark-package-for-central-australia">commitment</a> to “improve the response to fetal alcohol spectrum disorder (FASD) by the health and justice sectors”.</p>
<p>This is an important goal, but it is a big ask – the problems are complex and they are not new. FASD often goes undiagnosed and can cause severe and lifelong problems.</p>
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Read more:
<a href="https://theconversation.com/alcohol-warning-labels-need-to-inform-women-of-the-true-harms-of-drinking-during-pregnancy-134049">Alcohol warning labels need to inform women of the true harms of drinking during pregnancy</a>
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<h2>The heart of many problems</h2>
<p>Alcohol is behind or has been linked to many of the current problems in Central Australia, including the recent wave of crime and violence. Some believe this <a href="https://www.sbs.com.au/news/article/a-crime-wave-has-sparked-emergency-measures-in-alice-springs-heres-whats-going-on/3qcqvrkip">followed the relaxation</a> in July 2022 of the <a href="https://www.dss.gov.au/sites/default/files/documents/09_2012/stronger-futures-booklet-jul2012.pdf">Stronger Futures</a> laws that limited access to alcohol in many NT communities for more than a decade. </p>
<p>In communities where alcohol use is high, a focus on <a href="https://www.cdc.gov/ncbddd/fasd/facts.html#:%7E:text=Fetal%20alcohol%20spectrum%20disorders%20(FASDs)%20are%20a%20group%20of%20conditions,a%20mix%20of%20these%20problems.">FASD</a> is warranted. In Alice Springs, communities are <a href="https://www.abc.net.au/news/2023-02-04/fasd-fetal-alcohol-aboriginal-youth-crime-alice-springs/101854566">calling for action</a>.</p>
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<h2>Alcohol and pregnancy</h2>
<p>FASD is a <a href="https://www.fasdhub.org.au/fasd-information/assessment-and-diagnosis/guide-to-diagnosis/">condition</a> that affects people exposed to alcohol before birth and causes problems with motor skills, behaviour or learning, or a mix of these. </p>
<p>FASD is a result of alcohol’s ability to cross the placenta, so maternal and fetal blood alcohol concentrations rapidly reach the same level. Prenatal exposure to alcohol may disrupt development of the brain (neurodevelopment) and other organs in the unborn child. People born with FASD can <a href="https://pubmed.ncbi.nlm.nih.gov/26777270/">have</a> severe neurodevelopmental problems that may be accompanied by birth defects and have lifelong ramifications. </p>
<p>Worldwide, rates of FASD in the general population are <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2649225">estimated</a> at 1–5%, but we lack data in the general Australian population. Internationally, several identifiable groups are at <a href="https://pubmed.ncbi.nlm.nih.gov/30831001/">high risk</a> of FASD – children in foster and adoptive care, in orphanages, mental health facilities, juvenile justice, and some Indigenous groups. </p>
<p>Consistent with these data, <a href="https://pubmed.ncbi.nlm.nih.gov/28499185/">high rates</a> of FASD have been recorded in remote Australia (one in five) and in <a href="https://bmjopen.bmj.com/content/8/2/e019605">juvenile detention</a> (one in three). </p>
<p>But FASD is not selective. It <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2649225">occurs</a> across all socioeconomic levels and racial groups in society. </p>
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Read more:
<a href="https://theconversation.com/factcheck-qanda-does-australia-have-some-of-the-highest-rates-per-capita-of-fetal-alcohol-syndrome-in-the-world-57736">FactCheck Q&A: does Australia have some of the highest rates per capita of fetal alcohol syndrome in the world?</a>
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<h2>Often underdiagnosed</h2>
<p>Alcohol use in pregnancy is common throughout Australia. In cohort studies from our major cities, <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3354-9">about 60%</a> of pregnant women report drinking alcohol – often before realising they are pregnant. A pattern of <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12232">high-risk drinking</a> is reported in some remote communities. However, the Australian household survey suggests more educated, more affluent mothers are <a href="https://ada.edu.au/national-drug-strategy-household-survey-2019-5/">more likely to drink</a> throughout their pregnancy.</p>
<p>FASD has significant <a href="https://pubmed.ncbi.nlm.nih.gov/31628757/">economic costs</a> – through its impact on health, education, out-of-home care and justice systems. However, its <a href="https://doi.org/10.1093/oxfordhb/9780199935291.013.78">social impacts</a> are immeasurable.</p>
<p>Children born with FASD are <a href="https://pubmed.ncbi.nlm.nih.gov/26777270/">often slow</a> to develop the social skills and language, motor skills and attention, academic skills and impulse control that would otherwise help them achieve at school and contribute in their community.</p>
<p>They may strive to keep up with their peers but are often easily led and may be unable to distinguish right from wrong. With <a href="https://learningwithfasd.org.au/classroom-strategies/">good support</a> at home and school, children with FASD can thrive. Without it, children and young people <a href="https://bmjopen.bmj.com/content/8/2/e019605">may</a> drop out of school and some fall into a pattern of crime. </p>
<p>It is telling that many incarcerated children and youth have <a href="https://bmjopen.bmj.com/content/8/2/e019605">never had</a> a thorough medical and psychosocial assessment, and many have undiagnosed FASD. So, their strengths and needs have too long gone unrecognised and they have missed opportunities for vital early treatment. </p>
<p>The challenges of FASD are <a href="https://edmontonfetalalcoholnetwork.files.wordpress.com/2018/12/fasd_2nd_ed-2018.pdf">compounded</a> by early-life trauma. We must revert from a punitive to a therapeutic approach for these vulnerable children.</p>
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<figcaption><span class="caption">Every moment matters in your pregnancy.</span></figcaption>
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<h2>The focus so far</h2>
<p>For more than a decade, the Australian government has partnered with clinicians, researchers and others and has made a major contribution to addressing FASD.</p>
<p>After two <a href="https://www.aph.gov.au/parliamentary_business/committees/house_of_representatives_committees?url=spla/fasd/report.htm">national</a> <a href="https://parlinfo.aph.gov.au/parlInfo/download/committees/reportsen/024357/toc_pdf/Effectiveapproachestoprevention,diagnosisandsupportforFetalAlcoholSpectrumDisorder.pdf;fileType=application%2Fpdf">inquiries</a>, we have a <a href="https://aodknowledgecentre.ecu.edu.au/healthinfonet/getContent.php?linkid=613544&title=National+Fetal+Alcohol+Spectrum+Disorder+%28FASD%29+Strategic+Action+Plan+2018-2028&contentid=35916_1">National Strategic Action Plan for FASD</a> and a national <a href="https://www.fasdhub.org.au/fasd-information/about-us/governance/">FASD Advisory Group</a> to monitor implementation of its recommendations. The <a href="https://www.fasdhub.org.au/fasd-information/assessment-and-diagnosis/guide-to-diagnosis/">Australian Guide to the Diagnosis of FASD</a> has bolstered clinicians’ skills, and the <a href="https://www.fasdhub.org.au">FASD Hub website</a> is a valuable resource. </p>
<p>Local resources for <a href="https://learningwithfasd.org.au/">primary</a> and <a href="https://www.nofasd.org.au/service-providers/education/through-different-eyes/">early childhood educators</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/13218719.2020.1780643?journalCode=tppl20">justice professionals</a>, funded <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/372-million-for-foetal-alcohol-spectrum-disorder-support-and-awarenes">multidisciplinary clinics</a>, the <a href="https://www.nofasd.org.au/contact-us/">National Organisation for FASD</a> website and helpline, a FASD <a href="https://fasdregistry.org.au/">registry</a> to monitor trends, and a vibrant <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1754.2003.00281.x">research network</a> have collectively raised awareness and improved diagnosis and support for people living with FASD and their families.</p>
<p>However, FASD is still inadequately managed within the health and justice sectors in remote regions, including the NT, which are overwhelmed by the needs. </p>
<h2>What the new funds could achieve</h2>
<p>We need a systematic approach to identify all children with developmental and learning vulnerability and offer them treatment at the earliest possible opportunity. In any such child, we need to consider FASD and explore whether there might be a history of prenatal alcohol exposure. </p>
<p>We must increase our screening and diagnostic capacity – not only in specialised services, but in the places of first contact with health services: primary care, midwifery and community paediatric practices, in remote regions.</p>
<p>We also need trained professionals, available locally, to assist families to join the National Disability Insurance Scheme. But there is also a need for <a href="https://theconversation.com/use-it-or-lose-it-getting-ndis-funding-is-only-half-the-battle-for-participants-188530">accessible services</a>, including <a href="https://cdn.shopify.com/s/files/1/1613/1919/files/MWRC_NDIS_Report_2021.pdf?v=1649468403">where remote families live</a>, so they can spend the support funds they are allocated.</p>
<p>The need for culturally appropriate and trauma-informed services to support people with FASD and their families goes without saying. Training of more Aboriginal and Torres Strait Islander health workers is essential.</p>
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<h2>Prioritise prevention</h2>
<p>Prevention efforts must be <a href="https://www.phrp.com.au/issues/march-2015-volume-25-issue-2/fetal-alcohol-spectrum-disorders-in-australia-the-future-is-prevention/">at the fore</a> in the effort to address FASD. We must <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-584">understand</a> that disadvantage and historic trauma, addiction, and partner drinking and violence are among the most <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.13330">common drivers</a> of alcohol use in pregnancy, and shift the blame away from women. In turn, the drivers of disadvantage – inadequate housing, education and vocational opportunities, transport and access to good-quality education and health care – must be addressed. Australians must also relinquish their tolerant attitudes to binge drinking. </p>
<p>From July 2023, <a href="https://www.foodstandards.gov.au/industry/labelling/Pages/pregnancy-warning-labels-downloadable-files.aspx">pregnancy warning labels</a> will feature on all Australian alcohol products. Importantly, Australia’s first public awareness campaign – <a href="https://everymomentmatters.org.au/about/">Every Moment Matters</a> – is currently being rolled out nationally. It includes resources for the public, women at risk, and health professionals. And the <a href="https://twitter.com/catgiorgi/status/1625706451481268224">Strong Born</a> resources will be launched next week for Aboriginal and Torres Strait families and service providers.</p>
<p>All these efforts must be underpinned by legislation and strategies proven to reduce alcohol harms. Although unpopular, we must continue to push for restrictions on advertising and promotion of alcohol, appropriate taxation and pricing, and limit-setting on the number and opening hours of liquor outlets, especially in our most vulnerable communities.</p><img src="https://counter.theconversation.com/content/199673/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Elliott receives grant funding from the NHMRC, MRFF, the Ian Potter Foundation, Healthway WA, the NDIS, the Australian Government, NSW Health. She is on a number of committees related FASD including government, NGO and academic committees. </span></em></p>Fetal alcohol spectrum disorder can cause problems with movement, behaviour or learning or a mix of these. In communities where alcohol use is high, a focus on FASD is warranted.Elizabeth Elliott, Professor of Paediatrics & Child Health and Director of the Australian Paediatric Surveillance Unit, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1902242022-09-27T20:29:01Z2022-09-27T20:29:01ZWhy suicide prevention support is crucial for people with fetal alcohol spectrum disorder<figure><img src="https://images.theconversation.com/files/486689/original/file-20220927-25-he77l6.jpg?ixlib=rb-1.1.0&rect=17%2C224%2C5425%2C3763&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with FASD experience a range of vulnerabilities both from the impacts of prenatal alcohol exposure on the brain and body, and from the adverse life experiences commonly associated with this disability.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Fetal alcohol spectrum disorder (FASD) <a href="https://canfasd.ca/wp-content/uploads/2019/08/Toward-a-Standard-Definition-of-FASD-Final.pdf">is a lifelong disability</a> that affects the brain and body of people prenatally exposed to alcohol. <a href="https://doi.org/10.1080/19315864.2022.2082604">New research</a> is backing concerns raised by the FASD community about the high rates of suicidality among people with FASD. </p>
<p>As a team of FASD researchers and professionals who work with people with FASD, we are growing increasingly concerned with these statistics and stories we are hearing from caregivers. </p>
<h2>FASD and suicidality</h2>
<p>Suicidality is a <a href="https://doi.org/10.1521/suli.2007.37.3.264">spectrum of thoughts and behaviours</a> surrounding suicide. It encompasses suicidal ideation, suicide-related communication, suicide attempts and death by suicide. </p>
<p>Using data from Canada’s <a href="https://canfasd.ca/topics/diagnosis/#nationaldatabase">National FASD Database</a>, our team demonstrated that <a href="https://doi.org/10.1177/07067437211053288">suicidality among people with FASD was alarmingly high</a>. At some point during their lifetime, 25.9 per cent of our sample (206 of 796 individuals) experienced suicidal ideation or suicide attempt(s). Comparatively, rates in the general population range from <a href="https://doi.org/10.1177/0706743719878987">three per cent</a> to <a href="https://www.canada.ca/en/public-health/services/publications/healthy-living/suicide-canada-key-statistics-infographic.html">12 per cent</a>. </p>
<p>These findings are consistent with the current (albeit limited) research on FASD and suicide. Individuals with FASD often experience suicidality at <a href="https://doi.org/10.1177/1455072517707887">significantly younger ages</a> than those without FASD. </p>
<p>In a <a href="https://doi.org/10.1002/bdr2.1465">recent American study</a>, youth aged 13-18 years with FASD required medical assistance due to suicide attempts at rates 5.5 times higher than the general population. <a href="https://jptcp.com/index.php/jptcp/article/view/240">Other Canadian researchers</a> have reported suicide as a leading cause of death among a group of individuals with FASD. </p>
<figure class="align-right ">
<img alt="Graphic reading 'September is FASD awareness month' with an illustration of red sneakers" src="https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486691/original/file-20220927-22-he77l6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Initiatives like strengthening social supports, enhancing coping skills, hopefulness and positive future outlooks, as well as identifying reasons for living, are critical for suicide prevention.</span>
<span class="attribution"><span class="source">(CanFASD)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Because FASD is a multifaceted disorder, we must understand the <a href="https://doi.org/10.3389/fpsyg.2021.778471">complex reasons</a> this population may be at a higher risk for suicidality. </p>
<p>People with FASD experience a range of vulnerabilities both from the impacts of prenatal alcohol exposure on the brain and body, and from the adverse life experiences commonly associated with this disability. Research points to several individual, relational and environmental reasons for the high risk of suicidality among people with FASD. </p>
<h2>Individual factors</h2>
<p>Demographic factors like <a href="https://doi.org/10.1177/07067437211053288">age, region</a> and <a href="https://doi.org/10.1002/bdr2.1465">living situation</a> all play a role in the risk of suicidality among people with FASD, as do <a href="https://doi.org/10.1093/alcalc/agz049">neurodevelopmental challenges</a>, sleep problems and <a href="https://doi.org/10.3109/09638237.2011.577113">co-occurring mental health and substance use challenges</a>. </p>
<p>In our study, the odds of suicidality among people with FASD were 6.7 times higher for those with substance use challenges and 1.9 times higher for those with difficulties with affect regulation, which is the ability to control emotional responses. We found that experiences of depression, anxiety and post-traumatic stress disorder were high among people with FASD who experienced suicidality, which is worrisome considering these co-occurring diagnoses are common in this population. </p>
<h2>Relational factors</h2>
<p>Strong and stable relationships are an <a href="https://canfasd.ca/wp-content/uploads/publications/Final-Towards-Healthy-Outcomes-Document-with-links.pdf">important factor influencing healthy outcomes</a> for people with FASD. <a href="https://doi.org/10.3389/fpsyt.2022.931528">Conflict with others, social isolation and social disconnection</a> are common challenges for those who have FASD and suicidality. Being <a href="https://doi.org/10.1111/j.1530-0277.2011.01661.x">bullied</a> and <a href="https://jptcp.com/index.php/jptcp/article/view/446">feeling a lack of belonging</a> also contribute to a higher risk of suicidality. </p>
<p>The risk is also higher for individuals with a family history of substance use, suicidality or mental health concerns, or a personal history of trauma. We found that people with FASD who experienced trauma or abuse in their past were 2.8 times more likely to exhibit suicidality during their lifespan. </p>
<h2>Environmental factors</h2>
<figure class="align-center ">
<img alt="Illustration of a person talking to a counsellor" src="https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=340&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=340&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=340&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=428&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=428&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486694/original/file-20220927-22-wxakbg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=428&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Outcomes can be significantly improved with access to effective supports and services for physical and mental health. However, the lack of FASD-informed services is a big barrier.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In our <a href="https://doi.org/10.1177/07067437211053288">recent study</a> we also found higher rates of suicidality among people with prenatal alcohol exposure who lived in group homes and institutional settings such as custody or in-patient treatment. Interactions with institutional systems like <a href="https://doi.org/10.1016/j.chiabu.2020.104888">child welfare</a> and <a href="https://doi.org/10.1177/0706743718816064">justice</a> and negative experiences within health-care systems also play a role, as can the <a href="https://doi.org/10.1007/s10699-020-09676-y">multiple layers of stigma</a> that this population experiences. </p>
<p>Outcomes <a href="https://doi.org/10.3389/fpsyt.2022.931528">can be significantly improved</a> with access to effective supports and services for physical and mental health. However, the lack of FASD-informed services is a big barrier.</p>
<h2>Support for individuals, families and communities</h2>
<p>For those with FASD, having a stable and nurturing home environment is <a href="https://doi.org/10.1097/00004703-200408000-00002">an important protective factor</a> against mental health issues in general, so it stands to reason that <a href="https://canfasd.ca/wp-content/uploads/2019/10/FASD-X-Housing-Pei-2018_Amended-March-04-2019-dl.pdf">safe and secure housing</a> is important to reduce the likelihood of suicide. </p>
<p>Addressing factors like co-occurring mental health issues, social isolation, substance use, trauma, abuse and involvement with the justice system may also help to reduce risk. Initiatives like strengthening social supports, enhancing coping skills, hopefulness and positive future outlooks, as well as identifying reasons for living, are critical for suicide prevention. </p>
<p>The impact of suicidality in FASD is not confined only to individuals who have the disorder. The experiences of caregivers, families, friends and communities need to be included as well. </p>
<p>Even though our work identified that <a href="https://doi.org/10.1177/07067437211053288">one in three individuals with FASD experienced suicidality</a> at some point during their lives, this also means that two thirds of individuals <em>did not</em>. This raises a crucial question for September’s <a href="https://canfasd.ca/fasd-awareness-month/">Fetal Alcohol Spectrum Disorder Awareness Month</a>: What factors may bolster resilience and positive outcomes to protect individuals with FASD and their families from harmful outcomes? It’s essential that future research focuses on this area.</p>
<p><em>If you or someone you know is feeling suicidal, please contact <a href="https://talksuicide.ca">Talk Suicide Canada</a> (1-833-456-4566).</em></p><img src="https://counter.theconversation.com/content/190224/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kelly D. Harding works as a Research Associate and as the Director of Research Administration for The Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD). The original research reported in this article was supported by funding from PolicyWise for Children and Families. Publication of the research discussed in this article was supported by CanFASD. </span></em></p><p class="fine-print"><em><span>Carly McMorris: This work was supported by Policy Wise for Children and Families and CanFASD.</span></em></p><p class="fine-print"><em><span>Dorothy Badry does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fetal alcohol spectrum disorder (FASD) is a multifaceted disorder. There are complex reasons why this population may be at higher risk for suicide, suicide attempts and suicidal ideation.Kelly D. Harding, Adjunct Professor, Psychology, Laurentian UniversityCarly McMorris, Associate Professor of Education, University of CalgaryDorothy Badry, Professor, Social Work, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1455932020-09-20T11:54:44Z2020-09-20T11:54:44ZFetal alcohol spectrum disorder amid COVID-19: Fewer services, potential boost in rates<figure><img src="https://images.theconversation.com/files/357324/original/file-20200909-24-8g1odx.jpeg?ixlib=rb-1.1.0&rect=49%2C0%2C1228%2C850&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">iStock HR</span> <span class="attribution"><span class="source">(iStock)</span></span></figcaption></figure><p>Fetal alcohol spectrum disorder (FASD) is the leading <a href="https://doi.org/10.1503/cmaj.1040302">developmental disability</a> in Canada. Despite its preventable nature, there is concern among FASD researchers about a potential increase in <a href="https://doi.org/10.1016/S2468-2667(20)30159-6">FASD prevalence rates</a> as a result of COVID-19, in addition to the impact the pandemic is having on the community. </p>
<p>FASD is a lifelong disability affecting people who were exposed to alcohol prenatally. In Canada, <a href="https://doi.org/10.1186/s12889-019-7213-3">more people have FASD than autism spectrum disorder, cerebral palsy and Down syndrome combined</a>. </p>
<p>Current rates are conservatively estimated to be <a href="https://canfasd.ca/topics/prevalence/#1566501610553-4aece41f-3dc2">approximately four per cent</a> in North America. However, FASD is <a href="https://doi.org/10.1093/pch/14.4.231">very challenging to diagnose</a>, and many experts believe that its prevalence is <a href="https://doi.org/10.1001/jama.2017.21896">actually much higher</a>.</p>
<h2>COVID-19 compounds challenges in this community</h2>
<p><a href="https://canfasdblog.com/2020/08/07/life-with-covid-19-from-a-caregivers-perspective/">Anecdotally</a>, we know that individuals with FASD and their families are facing increased challenges as a result of this pandemic. Caregivers are concerned about a lack of supports, disruption in daily routine and mental health challenges. </p>
<p>Canadians with disabilities have drawn attention to their <a href="https://www.ctvnews.ca/health/coronavirus/disabled-canadians-feel-excluded-from-covid-19-messaging-1.4857691">exclusion from COVID-19 messaging</a>, as well to program cancellations and experiences of <a href="https://www.cbc.ca/news/health/covid-19-impact-on-canadians-with-disabilities-1.5525332">social isolation</a>.</p>
<p>While these disruptions can have a negative impact on all individuals, they can have greater consequences for individuals with FASD and their families. People with FASD thrive with <a href="https://www.fasdoutreach.ca/resources/all/0-9/8-magic-keys">consistency and routine</a>, but the pandemic has caused massive changes to our daily lives.</p>
<p>There is also concern about the future impact on mental health. While this body of evidence is still unfolding, parents reported changes in their children’s emotional state <a href="https://doi.org/10.31234/osf.io/5bpfz">in a recent preprint manuscript (a preliminary paper that has yet to be formally reviewed)</a>, including difficulty concentrating, boredom, irritability, restlessness and nervousness. Experiences of parenting stress are also higher during COVID-19 among families reporting these emotional changes in their children. </p>
<p>These findings are concerning, especially for families of individuals with FASD who report higher levels of <a href="https://doi.org/10.3109/13668250.2013.788136">parenting stress</a> compared to families of typically developing children and even those of children with other disabilities.</p>
<figure class="align-left ">
<img alt="Silhouette of a fetus and umbilical cord in a circle." src="https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=599&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=599&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=599&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=753&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=753&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358282/original/file-20200916-22-zqhl3e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=753&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Increased alcohol consumption during the pandemic may increase rates of FASD.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
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</figure>
<p>Little research has been conducted to date on the <a href="https://doi.org/10.1176/appi.ajp.2020.20060780">impact of COVID-19 on individuals with disabilities</a>. However, we cannot ignore the complexities of FASD when talking about the impact COVID-19 has had in Canada, especially in terms of feelings of increased social isolation and the reported <a href="https://doi.org/10.1111/jir.12769">lack of services and unmet needs</a> facing individuals and families during this time. </p>
<h2>Alcohol consumption is on the rise</h2>
<p>In addition to the challenges faced by individuals and their families living with FASD, the COVID-19 pandemic has also drawn attention to concerns about FASD prevention.</p>
<p>Recent global data have suggested that online alcohol sales for beer, wine and spirits have <a href="https://www.port.ac.uk/news-events-and-blogs/news/how-much-more-alcohol-are-we-really-drinking">risen by a staggering 291 per cent</a> during the pandemic, although that figure does not account for any decrease in in-person alcohol sales. The Canadian Centre on Substance Use and Addiction revealed that as many as <a href="https://www.ccsa.ca/sites/default/files/2020-06/CCSA-NANOS-Increased-Alcohol-Consumption-During-COVID-19-Report-2020-en_0.pdf">20 per cent of Canadians</a> have increased their alcohol use during COVID-19, and women report drinking, on average, more drinks per day than recommended in <a href="https://www.ccsa.ca/sites/default/files/2020-07/2012-Canada-Low-Risk-Alcohol-Drinking-Guidelines-Brochure-en_0.pdf">Canada’s Low Risk Alcohol Drinking Guidelines</a>. </p>
<p>Common reasons for the increase in alcohol consumption included a lack of a regular schedule, boredom, stress and loneliness. </p>
<p>There is currently no data to quantify if there has been an increase in alcohol use during pregnancy. However, the rise in general alcohol consumption raises concerns about the potential increase in <a href="https://theprovince.com/opinion/op-ed/lorraine-greaves-and-nancy-poole-sex-booze-and-the-three-of-you/wcm/67f23896-cd9b-4443-8138-e602e1e8a291/">alcohol-exposed pregnancies</a>. </p>
<figure class="align-center ">
<img alt="A pregnant woman sitting on a sofa holds up her hand to decline a glass of wine." src="https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/358473/original/file-20200916-14-9mn1yq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Increased alcohol consumption during the pandemic could potentially affect rates of FASD.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Alcohol can impact fetal development at any stage of pregnancy. There is no known safe amount, safe time or safe type of alcohol, but women often don’t know they’re pregnant until several weeks along and approximately <a href="https://doi.org/10.1111/j.1728-4465.2014.00393.x">half of all pregnancies are unplanned</a>. </p>
<p><a href="http://www.thinkfasd.ca/">Experts recommend</a> that individuals and couples go alcohol-free if they are pregnant, trying to get pregnant or having unprotected sex, which increases the risk for an unplanned pregnancy. Individuals and couples who wish to continue drinking should use reliable forms of contraception or go alcohol-free until they know they are not pregnant.</p>
<h2>Awareness and understanding are key</h2>
<p>Reducing the number of alcohol-exposed pregnancies is an important step forward in helping to reduce the prevalence of FASD. However, encouraging individuals and couples to go alcohol-free is only one piece of the broader FASD puzzle. The realities of the pandemic have also highlighted the lack of supports and services available for people with FASD and their families. </p>
<p>Addressing FASD in Canada is complex. Supportive policies, effective support and accessible services are all important pieces in a more comprehensive FASD plan, but they are not enough. In order to effectively address this national issue, we need all Canadians engaged and united with awareness and understanding. </p>
<p>A greater public awareness and understanding brings FASD into the spotlight. During <a href="https://canfasd.ca/fasd-awareness-month/">FASD Awareness Month</a>, I encourage Canadians to learn more about FASD, alcohol and pregnancy. Addressing and preventing FASD in Canada is all of our responsibility.</p><img src="https://counter.theconversation.com/content/145593/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kelly D. Harding works as a Research Associate for the Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD).</span></em></p>COVID-19 is not only disrupting services for people with fetal alcohol spectrum disorder (FASD) and their families, but may also be linked to an increase in rates due to an uptick in alcohol use.Kelly D. Harding, Adjunct Professor, Psychology, Laurentian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1090782019-02-24T19:15:21Z2019-02-24T19:15:21ZDid you look forward to last night’s bottle of wine a bit too much? Ladies, you’re not alone<figure><img src="https://images.theconversation.com/files/260356/original/file-20190222-195873-1jee4q8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia's alcohol guidelines recommend women and men drink no more than two standard drinks per day. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/tAH2cA_BL5g">Kelsey Chance</a></span></figcaption></figure><p>This month, close to 40,000 people, mostly women, have given up alcohol for <a href="https://www.febfast.org.au">FebFast</a> and many others will be participating in <a href="https://www.dryjuly.com">Dry July</a>. </p>
<p>These events began as fundraisers for various social causes. But the <a href="https://www.vichealth.vic.gov.au/-/media/ResourceCentre/PublicationsandResources/alcohol-misuse/Evaluation-of-febfast-participation_Full-Report.pdf?la=en&hash=0172F59BF74212BB0B9EA055CA0E7931EAC2CB39">main reasons</a> people cite for participating are related to personal benefits, including giving their body a break from alcohol and improving their health.</p>
<p>The proportion of young people drinking has decreased over the past ten years. But more women in their <a href="https://theconversation.com/young-australians-are-drinking-less-but-older-people-are-still-hitting-the-bottle-hard-90024">40s and 50s are drinking at risky levels</a>. And women are <a href="https://theconversation.com/womens-alcohol-consumption-catching-up-to-men-why-this-matters-67454">catching up to men</a> when it comes to drinking at levels that damage health.</p>
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<a href="https://theconversation.com/womens-alcohol-consumption-catching-up-to-men-why-this-matters-67454">Women's alcohol consumption catching up to men: why this matters</a>
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<p>Women’s relationship with alcohol has become a hot topic. Many women, including celebrities <a href="https://www.newshub.co.nz/home/lifestyle/2018/10/nigella-lawson-reveals-the-reason-why-she-s-cut-back-on-alcohol.html">Nigella Lawson</a>, <a href="https://theweek.com/articles/514528/why-kristin-davis-sobered">Kristen Davis</a> and <a href="http://www.contactmusic.com/will-smith/news/jadas-boozy-background">Jada Pinkett Smith</a>, have been vocal about their decisions to reduce drinking to improve their health and well-being.</p>
<h2>Women are affected by alcohol more than men</h2>
<p>Women start to have <a href="https://pubs.niaaa.nih.gov/publications/aa46.htm">alcohol-related problems sooner</a> and at lower drinking levels than men.</p>
<p>If a man and a woman drink the same amount, in general a woman’s blood alcohol concentration will be higher. </p>
<p>Women tend to be smaller and lighter than men; a person who is a lighter weight or who has a smaller body frame will be more affected than someone who weighs more or has a larger body frame. If the same amount of alcohol is going into a smaller body there will be a higher concentration of alcohol.</p>
<p>Even if a man and woman are the same size, women tend to have a higher percentage of body fat and a lower percentage of body water than men. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/zSKsSrXXj7E?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s what happens when we take the first, second and fifth drink.</span></figcaption>
</figure>
<p>Dehydrogenase is the enzyme that breaks down alcohol in the body. Women tend to have less active dehydrogenase and therefore take longer to process alcohol, so they will get drunk faster and have alcohol in their system for longer.</p>
<p>Women who drink experience <a href="http://www.center4research.org/women-dangers-drinking/">health problems sooner</a> and that are more severe than men who drink the same amount.</p>
<h2>Women are less likely to seek help</h2>
<p>Even when women are experiencing problems with alcohol, they are less likely to seek help than men. Women represent only one-third of Australians who <a href="https://www.aihw.gov.au/reports/alcohol-other-drug-treatment-services/aodts-2016-17-key-findings/contents/clients">receive treatment</a> from a specialist alcohol and drug treatment service.</p>
<p>Barriers to women seeking treatment include social stigma, fear of losing their children, and lack of <a href="https://www.sciencedirect.com/science/article/pii/S0740547210000620">availability of specific programs</a> for women.</p>
<h2>How can too much affect your health?</h2>
<p>Alcohol can increase the risk of significant health problems, including <a href="https://wiki.cancer.org.au/policy/Alcohol/Impact:_Alcohol_and_cancer">cancer</a>, <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/alcohol-related-brain-impairment">brain damage</a>, <a href="https://www.racgp.org.au/afp/2011/august/alcoholic-liver-disease/">liver disease</a> and <a href="https://www.heartfoundation.org.au/healthy-eating/food-and-nutrition/drinks/drinking-alcohol">heart disease</a>.</p>
<p>Women who are pregnant or trying to get pregnant should not drink alcohol at all until the baby is born. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-are-the-risks-of-drinking-before-you-know-youre-pregnant-59603">Health Check: what are the risks of drinking before you know you're pregnant?</a>
</strong>
</em>
</p>
<hr>
<p>If you drink while <a href="https://www.pregnancybirthbaby.org.au/alcohol-and-pregnancy">pregnant</a>, the alcohol can go through your blood and to the baby. This can cause deformities and cognitive damage in the baby, known as <a href="https://www.nofasd.org.au/alcohol-and-pregnancy/what-is-fasd/">fetal alcohol syndrome</a>.</p>
<p>If you are breastfeeding, small amounts of alcohol can go through the breast milk to the baby. It’s better to drink after breastfeeding times rather than before or during.</p>
<h2>How much is too much?</h2>
<p>The idea that a little bit of alcohol is good for your health has <a href="https://www.abc.net.au/news/2016-03-22/studies-linking-alcohol-to-health-benefits-flawed-researchers/7264040">now been debunked</a>.</p>
<p>The <a href="http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/guide-adult">Australian alcohol guidelines</a> recommend healthy adults (men and women) should drink no more than two standard drinks on any day to reduce lifetime risk of harm from alcohol-related disease.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/260121/original/file-20190221-195883-15ulx07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/260121/original/file-20190221-195883-15ulx07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/260121/original/file-20190221-195883-15ulx07.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/260121/original/file-20190221-195883-15ulx07.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/260121/original/file-20190221-195883-15ulx07.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/260121/original/file-20190221-195883-15ulx07.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/260121/original/file-20190221-195883-15ulx07.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Two standard drinks equals around 200ml of wine.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Z_NBiiq0Zgc">Chris Montgomery</a></span>
</figcaption>
</figure>
<p>The guidelines also recommend consuming a maximum of four standard drinks on a single occasion to reduce the risk of alcohol-related injury.</p>
<p>The percentage of pure alcohol varies across different types of drinks, so the guidelines convert alcohol to <a href="http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/Content/drinksguide-cnt">standard drinks</a>. In Australia, a standard drink contains ten grams of alcohol, which equates to 100mls of wine or 285mls of regular strength beer or cider (a middy* or pot) or 30mls of regular strength spirit. A cosmopolitan or mojito typically has two or three standard drinks.</p>
<h2>Signs you need may need to cut back</h2>
<p>Are you:</p>
<ul>
<li><p>drinking every day or nearly every day? Daily drinking is associated with dependence</p></li>
<li><p>drinking more than <a href="http://www.alcohol.gov.au/internet/alcohol/publishing.nsf/content/36E6FEE732C8DF1BCA25767200769CD8/$File/adult.pdf">the recommended limits</a>? Drinking more than two drinks on any day is associated with long-term health problems</p></li>
<li><p>needing to drink more to get the same effect? This indicates growing tolerance to alcohol and is an early sign of dependence</p></li>
<li><p>having difficulty taking a break or cutting back, or drinking more than you intended to? These are signs that you have less control over how much you drink</p></li>
<li><p>finding that drinking is interfering with day-to-day activities on a regular basis, for example being late for work because you have a hangover?</p></li>
<li><p>noticing your well-being is affected, for example, you get feelings of anxiety or depression during or after drinking, or you have trouble sleeping? Alcohol can be relaxing while you are drinking, but it can make anxiety, depression and sleep <a href="https://theconversation.com/four-ways-alcohol-is-bad-for-your-health-92578">problems worse</a></p></li>
<li><p>doing things while you are drinking that you later regret?</p></li>
</ul>
<p>If so, it’s time to reassess your drinking. This <a href="http://www.justaskus.org.au/online-alcohol-assessment">online assessment tool</a> may help.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/260357/original/file-20190222-195861-eoirna.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/260357/original/file-20190222-195861-eoirna.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/260357/original/file-20190222-195861-eoirna.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/260357/original/file-20190222-195861-eoirna.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/260357/original/file-20190222-195861-eoirna.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/260357/original/file-20190222-195861-eoirna.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/260357/original/file-20190222-195861-eoirna.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If drinking is interfering with your day-to-day activities, it might be time to cut back.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Ow3RGs0WiXI">Stage 7 Photography</a></span>
</figcaption>
</figure>
<h2>How to cut back</h2>
<p>If you’re drinking more than you’d like to, make a plan to cut back. This might include:</p>
<ul>
<li><p>setting a limit that reduces health risks</p></li>
<li><p>having alcohol-free days every week</p></li>
<li><p>having non-alcoholic “spacers” before and in-between alcoholic drinks</p></li>
<li><p>sipping your drinks rather than gulping them down. Slowing your drinking enables your body to process the alcohol and you also end up drinking less</p></li>
<li><p>trying drinks with a lower alcohol content</p></li>
<li><p>eating before and/or while you are drinking. This helps slow the absorption of alcohol</p></li>
<li><p>avoiding “shouts”. If you do, don’t feel like you need to keep up with everyone else. You can skip a round or two.</p></li>
</ul>
<h2>Where to get help cutting back or quitting</h2>
<p>Most women who drink alcohol, even those who drink a little too much, don’t need specialist treatment, but taking a break from alcohol can improve your physical and mental well-being.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/four-ways-alcohol-is-bad-for-your-health-92578">Four ways alcohol is bad for your health</a>
</strong>
</em>
</p>
<hr>
<p>If you need help to cut back there are some resources online that may help (such as <a href="https://www.hellosundaymorning.org/">Hello Sunday Morning</a>). </p>
<p>Your GP is a good place to start if you have questions or concerns about your drinking.</p>
<p>You can also talk to someone on the phone or online for information:</p>
<p><a href="https://www.counsellingonline.org.au">CounsellingOnline</a> is a free online chat for concerns about alcohol and other drugs. Anyone can use it – people using drugs and people wanting to help friends or family using drugs.</p>
<p>National Alcohol and other Drug Hotline is a free telephone information and counselling service similar to CounselingOnline, but on the phone. They can be reached at 1800 250 015.</p>
<p><em>* This article originally said a stubbie or pot contained 285mls. This has now been corrected to middy or pot.</em></p><img src="https://counter.theconversation.com/content/109078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a paid consultant in the alcohol and other drug sector. She runs retreats for women wanting a break from alcohol. She has previously been awarded grants by state and federal governments, NHMRC and other public funding bodies for alcohol and other drug research.</span></em></p>When it comes to drinking at risky levels, women are catching up to men. Problem is, women start to have alcohol-related problems sooner and at lower drinking levels than men.Nicole Lee, Professor at the National Drug Research Institute, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1045322018-10-10T23:03:21Z2018-10-10T23:03:21ZNew guide kick-starts reconciliation in the justice system<figure><img src="https://images.theconversation.com/files/240127/original/file-20181010-72110-5onwuz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Concrete action steps are needed to help reconciliation, says a research team that offers 12 actionable ideas. Here Ben Paul, of the Musqueam First Nation, sings and plays a drum during the Walk for Reconciliation in Vancouver, B.C., on Sept. 24, 2017, held to promote positive relations between Indigenous and non-Indigenous people in Canada.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><p>It’s been almost three years since the release of the <a href="http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Exec_Summary_2015_05_31_web_o.pdf">final report of the Truth and Reconciliation Commission (TRC)</a> on the systematic abuse and intergenerational trauma wrought by Indian Residential Schools in Canada. That program was a colonial project that took Indigenous children out of their homes and placed them in residential schools with an aim to <a href="http://www.trc.ca/websites/trcinstitution/index.php?p=39">“kill the Indian in the child.”</a></p>
<p>The TRC was part of a class-action settlement against the Government of Canada and aimed to collect truths as part of a path towards reconciliation, but there remains a substantial amount of work to do. </p>
<p>At the federal level, the TRC report with its <a href="http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Calls_to_Action_English2.pdf">94 Calls to Action</a> was initially greeted with <a href="https://www.theglobeandmail.com/news/politics/ottawa-remains-silent-on-truth-and-reconciliation-recommendations/article24785944/">stunning silence</a>. Although the 94 Calls to Action became more visible on the public stage in the months that followed, including <a href="https://pm.gc.ca/eng/mandate-letters">being part of mandate letters sent to public officials</a>, there is a silence that lingers.</p>
<p>For many, the mandate to take action was too broad. For others, the work of reconciliation was seen as neither their calling nor responsibility. The net effect, in many areas, has been a lack of action or a stall despite an urgent need otherwise. </p>
<p>This week, my research team at the University of Regina hopes to change this. Released in partnership with Canada FASD Research Network, the <a href="https://canfasd.ca/trc34/">Framework For Action</a> aims to help frontline workers, policymakers and researchers engage with the issues and create action plans for one of the TRC’s Call to Action related to the justice system - #34.</p>
<p>The TRC Call to Action #34 calls upon “the governments of Canada, the provinces, and territories to undertake reforms to the criminal justice system to better address the needs of offenders with fetal alcohol spectrum disorder (FASD).”</p>
<h2>The justice system and FASD</h2>
<p>There are 17 different calls to action that speak to the legacy of the residential schools in relation to the justice sector. Two of those calls focus on fetal alcohol spectrum disorder, a diagnostic term used to describe impacts on the brain and body of individuals exposed to alcohol during pregnancy. </p>
<p>While FASD can impact anyone exposed to alcohol during gestation, the fact that FASD is mentioned in two of the Calls to Action outlines the seriousness of the issue. This is a social justice issue for Indigenous and non-Indigenous communities alike. Indigenous families impacted by intergenerational trauma might be having children who have FASD. These children can find themselves embroiled in a system, a justice system that is often <a href="http://biblioteca.cejamericas.org/bitstream/handle/2015/4719/Rudin.pdf?sequence=1&isAllowed=y">incarcerating versus accommodating or understanding of the nuanced issues facing Indigenous peoples.</a></p>
<p>FASD is a complex disability. Research indicates it can be <a href="https://www.jstor.org/stable/41995627?seq=1#metadata_info_tab_contents">overrepresented in both youth</a> and <a href="http://www.justice.gov.yk.ca/pdf/Corrected_McLachlan_Final_Report_to_Yukon_August_2017.pdf">adult populations in the criminal justice system.</a> There is a need for more research to <a href="https://canfasd.ca/wp-content/uploads/sites/35/2018/02/Flannigan.etal_.2018.FASD_justice_review.pdf">expand the use of evidence to influence policies and practices.</a></p>
<p>Recent reports from Statistics Canada noted that rates of incarceration of Indigenous peoples have been <a href="https://www150.statcan.gc.ca/n1/pub/85-002-x/2018001/article/54972-eng.htm">“trending upwards for over 10 years.”</a> Indigenous peoples make up over 28 per cent of the overall male prison population and 43 per cent of the female prison population, even though they are less than five per cent of the general population. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/broken-system-why-is-a-quarter-of-canadas-prison-population-indigenous-91562">Broken system: Why is a quarter of Canada's prison population Indigenous?</a>
</strong>
</em>
</p>
<hr>
<p>FASD is a lifelong disability. Like many disabilities, FASD is stigmatized and individuals can face marginalization. However, unlike many disabilities, <a href="https://doi.org/10.1177/1363461509102291">FASD can follow a “racialized script”</a> that is inaccurate but can serve to produce health and social welfare disparities. </p>
<p>While individuals with FASD experience challenges in their daily living, and may struggle with motor skills, physical health, learning, memory, attention, emotional regulation and social skills, <a href="https://canfasd.ca">individuals with FASD are unique and have both strengths and challenges</a>. </p>
<h2>Ongoing trauma</h2>
<p>During the process of the TRC, commissioners collected testimony from over 6,000 witnesses across Canada over six years. The witnesses shared their experiences of physical, emotional and sexual abuse in the residential schools. They also shared their lived experiences of ongoing systemic oppression and trauma. </p>
<p>A group of individuals with a complex disability find themselves over-represented in the justice system. This is a serious social justice issue that demands attention.</p>
<p>The <a href="https://canfasd.ca/trc34/">Framework for Action</a> includes recommendations that could directly address the over-incarceration of Indigenous peoples. </p>
<p>Using an interdisciplinary and <a href="https://canfasd.ca/wp-content/uploads/sites/35/2017/08/Final-Report-FASD-Justice-Reconciliation-final-07-17.pdf">evidence-based approach that links research, policy and frontline practices</a>, the framework offers a cluster of recommendations that aim to bring about real-world changes to improve the lives of individuals impacted by this disability. </p>
<p>While the Call to Action #34 is located in the justice sector, the issues related to FASD permeate across many sectors and therefore require more than justice reform. There are many ways to intervene against the alarming rates of individuals with FASD presenting in the justice system. </p>
<p>Ideas range from better community supports and case management to mandatory education about the disability and its contributing factors.</p>
<p>The TRC final report notes “reconciliation is not an Aboriginal problem; it is a Canadian one. Virtually all aspects of Canadian society may need to be reconsidered.” </p>
<p>The Framework for Action on #34 recognizes that change comes about through small and large steps. We offer <a href="https://canfasd.ca/wp-content/uploads/sites/35/2018/10/TRC34-A-Framework-for-Action.pdf">12 concrete ideas</a> on how to take some of these collective steps in the right direction.</p><img src="https://counter.theconversation.com/content/104532/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Stewart has received funding from Canada FASD Research Network, the University of Regina, the Canadian Institutes of Health Research, Social Sciences and Humanities Research Council, Canada Council for the Arts and the Saskatchewan Health Research Foundation. Michelle is affiliated with the University of Regina and Canada FASD Research Network. </span></em></p>It’s been three years since the TRC released its report on the lasting impact of residential schools in Canada but responses to the 94 Calls to Action have been slow. A new framework hopes to change that.Michelle Stewart, Associate Professor of Justice Studies; Director of the Community Research Unit, University of ReginaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1032402018-10-10T23:03:20Z2018-10-10T23:03:20ZThe truth about fetal alcohol spectrum disorder<figure><img src="https://images.theconversation.com/files/240845/original/file-20181016-165924-1vl9cxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Approximately 11 per cent of Canadian mothers report consuming alcohol during pregnancy, which can cause fetal alcohol spectrum disorder (FASD) in their children. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Fetal alcohol spectrum disorder (FASD) is often overlooked and understudied. Caused by prenatal alcohol exposure, it is sometimes referred to as an “invisible disorder.” </p>
<p>But FASD is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27892236">most common preventable cause of developmental disability</a>. Many who have it experience <a href="https://doi.org/10.1503/cmaj.141593">lifelong behavioural, intellectual, neurological and mental health difficulties.</a></p>
<p>Individuals with FASD and their families also face <a href="https://doi.org/10.1093/phe/phv012">persistent stigma, negative stereotypes and harmful biases,</a> due to public misunderstandings. </p>
<p>Negative public attitudes are detrimental to people living with FASD, impacting their self-esteem and beliefs in their own capabilities. Research shows that <a href="https://www.canada.ca/en/public-health/services/diseases/fetal-alcohol-spectrum-disorder/support.html">with the right supports</a>, individuals with FASD can live <a href="https://www.ncbi.nlm.nih.gov/pubmed/22042791">productive and successful lives</a>. However a common, and often inaccurate, misconception is that these individuals are destined to be lifelong “burdens” on health and social systems. </p>
<p>As FASD researchers, we want to dispel common misunderstandings about children and youth with FASD, and offer some evidence-based truths.</p>
<h2>More common than autism</h2>
<p>FASD is alarmingly common, with an <a href="https://canfasd.ca/wp-content/uploads/sites/35/2018/08/Prevalence-1-Issue-Paper-FINAL.pdf">estimated four per cent of Canadians</a> having the disorder, far <a href="https://www.ncbi.nlm.nih.gov/pubmed/9451756">more than previously thought</a>. Affecting approximately 1.5 million Canadians, this means it <a href="https://canfasd.ca/wp-content/uploads/sites/35/2018/08/Prevalence-1-Issue-Paper-FINAL.pdf">is 2.5 times more prevalent than autism spectrum disorder</a>.</p>
<p>FASD affects children and youth across all races, ethnicities, cultures and socioeconomic status. In Canada, women of all ages and backgrounds consume alcohol. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/240136/original/file-20181010-133328-u04dit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/240136/original/file-20181010-133328-u04dit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240136/original/file-20181010-133328-u04dit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240136/original/file-20181010-133328-u04dit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240136/original/file-20181010-133328-u04dit.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240136/original/file-20181010-133328-u04dit.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240136/original/file-20181010-133328-u04dit.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It is not necessarily possible to tell by looking at children whether they do or do not have FASD.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Despite <a href="http://www.fasdontario.ca/cms/service-areas/prevention/effective-strategies-to-prevent-alcohol-use-in-pregnancy/">recent prevention efforts</a>, approximately <a href="http://bccewh.bc.ca/wp-content/uploads/2014/06/FASD-BIG-Infographics-Combined.-June.-2014.websized1.pdf">11 per cent of Canadians mothers</a> report consuming alcohol during pregnancy, with more than three per cent reporting alcohol binges during pregnancy. This is probably an underrepresentation, as some mothers deny drinking during pregnancy due to negative stigma.</p>
<p>You also can’t necessarily tell that someone has FASD by how they look. Less than <a href="https://doi.org/10.1002/9783527632510.ch7">10 per cent of individuals with FASD have the associated facial features</a> — short palpebral fissures, smooth philtrum and thin upper lip. </p>
<p>For most individuals living with FASD, the invisibility of the disorder is problematic because it acts as a barrier to early identification and treatment, both of which <a href="https://doi.org/10.1002/ddrr.68">are important for long-term outcomes</a>.</p>
<h2>Vulnerable to depression and abuse</h2>
<p>Many children and youth with FASD also experience secondary conditions. Mental health disorders are seen <a href="https://doi.org/10.3109/09638237.2011.577113">in over 90 per cent of individuals with FASD</a>, compared to 20 per cent of the general population. Depression and anxiety are among the most common. One study showed that depression <a href="https://www.ncbi.nlm.nih.gov/pubmed/9546004">affected 45-50 per cent</a> of a small group of individuals with FASD; another study showed anxiety to impact <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410752/">20-40 per cent</a>.</p>
<p>Prenatal alcohol exposure does not cause all of the secondary issues seen in FASD. This is because prenatal alcohol exposure <a href="https://www.ncbi.nlm.nih.gov/pubmed/20335648">rarely occurs in isolation</a>. Children with FASD frequently experience other adverse childhood events, such as maltreatment, neglect or trauma. </p>
<p>In one study, 34 per cent of individuals exposed to alcohol prenatally were physically abused, and 24 per cent were sexually abused. </p>
<p>It is often difficult to disentangle what child outcomes are related to alcohol exposure and what result from other adverse experiences.</p>
<h2>Verbal, artistic and friendly</h2>
<p>Intelligence and thinking abilities vary in children and youth with FASD, due to variability in the types and frequency of their mothers’ drinking during pregnancy, as well as genetics and environmental factors. </p>
<p><a href="https://doi.org/10.1097/01.alc.0000175040.91007.d0">Executive functioning difficulties</a>, memory problems, language delays, visuospatial difficulties, attention problems and reduced IQ are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3104937/">common in this population</a>. However, FASD differentially affects every individual, resulting in <a href="https://doi.org/10.1080/09297049.2017.1302579">unique areas of strengths and difficulties</a>. </p>
<p>While <a href="http://www.intellectualdisability.info/diagnosis/articles/fetal-alcohol-spectrum-disorder">many children and youth with FASD have average IQs</a>, these areas of strength may be overlooked or overshadowed by behavioural problems.</p>
<p>All kids have strengths, and <a href="https://fncaringsociety.com/sites/default/files/FPCFR%20journal%208(1)%202013_1.pdf">children with FASD are no exception</a>. Many are highly verbal, artistic, outgoing and friendly.</p>
<p>FASD does not disappear over time. It is a lifelong, pervasive disorder that requires a lifetime of supports. Issues associated with FASD may actually worsen over time. Research shows that individuals with FASD <a href="https://www.springer.com/gp/book/9783319717548">may be at risk for substance use issues</a> and other co-occurring <a href="https://doi.org/10.3109/09638237.2011.577113">mental health disorders</a> well into adulthood.</p>
<h2>We must ditch our stereotypes</h2>
<p>Despite this, <a href="https://www.cdc.gov/ncbddd/fasd/treatments.html">early diagnosis and intervention</a> may reduce some of the challenges faced by kids with FASD. While there is no cure, some interventions have shown effectiveness in improving common difficulties. </p>
<p>For example, <a href="https://www.ncbi.nlm.nih.gov/pubmed/26578111">recent research that has focused on improving self-regulation and attentional control</a> in children with FASD show improvements in lots of areas. This is evident through parent and caregiver reports, neuropsychological testing and magnetic resonance imaging (MRI) scans.</p>
<p>To best meet the needs of children and youth with FASD, it is essential to try to understand the whole child in their context, all their experiences and their individual strengths and differences.</p>
<p>To maximize the best outcomes for these children, we also need to be aware of our own biases and stereotypes. These can be harmful to the very children and families who need our support the most.</p><img src="https://counter.theconversation.com/content/103240/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carly McMorris receives funding from the Mental Health and Addiction Strategic Clinical Network Grant, through Alberta Health Services. </span></em></p><p class="fine-print"><em><span>Catherine Lebel receives funding from the Mental Health and Addiction Strategic Clinical Network Grant, through Alberta Health Services. </span></em></p><p class="fine-print"><em><span>Chantel Ritter does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With an estimated prevalence of four per cent, fetal alcohol syndrome disorder (FASD) is more common than autism. And yet is it surrounded by myth and stigma.Carly McMorris, Assistant Professor of Education, University of CalgaryCatherine Lebel, Assistant Professor of Radiology, University of CalgaryChantel Ritter, MSc student in School and Applied Child Psychology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/528352016-01-13T11:51:35Z2016-01-13T11:51:35ZHow foetal alcohol spectrum disorders could be a hidden epidemic<figure><img src="https://images.theconversation.com/files/107664/original/image-20160108-3317-1nq3qpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There is no safe limit of alcohol consumption during pregnancy</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=pregnant&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=232623784">www.shutterstock.com</a></span></figcaption></figure><p>The new Department of Health <a href="https://www.gov.uk/government/consultations/health-risks-from-alcohol-new-guidelines">guideline on alcohol</a> says that there is no safe alcohol limit for pregnant women. Alcohol should simply be avoided. </p>
<p>Alcohol exposure during pregnancy can cause damage to the body and brain of the baby, causing a range of lifelong problems. These problems are grouped under the umbrella term “foetal alcohol spectrum disorders” (FASD). The most recognised form of FASD is foetal alcohol syndrome (FAS). People with FAS have distinctive facial features, are small for their age and have problems with learning. </p>
<p>The exact number of drinks a woman can have before harming her baby is unknown (and is likely to vary from woman to woman), so most countries, including Canada, Australia and the USA, have taken a conservative approach and recommended that no alcohol is the safest option. This new guideline now brings the UK in line with those and many other countries. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=679&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=679&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=679&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=853&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=853&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107665/original/image-20160108-3304-1vt1h13.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=853&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Signs of FAS.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3APhoto_of_baby_with_FAS.jpg">Teresa Kellerman/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p><a href="http://tinyurl.com/jbntjdj">Recent research</a> has revealed a large number of problems experienced by people with FASD. Around half of all people with FASD have attention-deficit hyperactivity disorders (ADHD), 62% have vision impairment (a rate more than 30 times higher than the general population), 58% have hearing problems (more than 100 times higher than the general population), 83% have speech and language delays and 91% suffer from impulsivity and inappropriate behaviour. </p>
<p>Each person with FASD may have some or all of these problems, and each person may have these problems from a mild to severe degree.</p>
<h2>May be as prevalent as autism</h2>
<p>We don’t know how many people have FASD in the UK, but based on a <a href="http://onlinelibrary.wiley.com/doi/10.1111/acer.12939/abstract">large review</a> of data from other countries, it’s estimated that it may affect as much as 2% of the population. This would put FASD on a par with well-recognised developmental disorders such as autism spectrum disorder. In fact, a significant proportion of children currently diagnosed with <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938300/">ADHD</a> or <a href="http://www.sciencedirect.com/science/article/pii/S0149763410002149">autism</a> may have undiagnosed FASD as an underlying cause of their learning problem. </p>
<p>One problem with recognising the extent of the hidden epidemic is that FASD is <a href="http://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-11-14">significantly under reported</a>. For example, out of a search of five years’ worth of outpatient hospital data in England, no cases of FASD were recorded. The researchers also looked at hospital admission data, expecting to find that areas with higher levels of alcohol-related illness in young women (such as in the north-west and north-east of England) would also have higher levels of FASD. This was not the case, suggesting that either FASD is not diagnosed, or it is diagnosed but not routinely recorded in hospital data. </p>
<h2>A difficult diagnosis</h2>
<p>Diagnosis is dogged by difficulties, including the fact that many healthcare professionals don’t know much about FASD and specialist training is needed to make a diagnosis. <a href="http://bmaopac.hosted.exlibrisgroup.com/exlibris/aleph/a21_1/apache_media/3UQ4QIHNR25DH7623BMFDY45UIK7LH.pdf">A diagnosis</a> has to be made by a team of different professionals following a thorough assessment of the child that involves a physical examination, intelligence tests, occupational and physical therapy, and psychological, speech and neurological evaluations, as well as genetic tests to rule out genetic causes of problems. </p>
<p>Another difficulty with getting a diagnosis is that the behavioural and developmental problems that are signs of FASD may not emerge until a child is at primary school, by which time vital evidence about whether the birth mother drank during pregnancy may be missing. This information is crucial to make a diagnosis if the distinctive facial features seen in full-blown FAS are not present. Another difficulty is that people with FASD usually have other disorders (such as ADHD or autism spectrum disorder), making it difficult to isolate FASD. </p>
<p>To get the true number of people with FASD, it would be necessary to screen a whole group of the general population. This has been done in other countries, such as Italy, the USA and Canada, but there has been no such study in the UK.</p>
<h2>Action at last</h2>
<p>Last summer, a cross-party group of MPs took an interest in FASD, forming the <a href="http://www.appg-fasd.org.uk/">All Party Parliamentary Group (APPG) for FASD</a>. In its first <a href="http://www.appg-fasd.org.uk/download/i/mark_dl/u/4013133754/4625658887/APPG%20on%20FASD%20Initial%20Inquiry%20Report.pdf">report</a>, released in December 2015, it made a number of recommendations including the call for a public health campaign to raise awareness of FASD. The APPG also called for “urgent consideration to be given by the government into commissioning a UK-wide study to ascertain the prevalence of FASD”. This would be a vital first step in uncovering the true extent of FASD. </p>
<p>Why is such recognition important? The consequences of unrecognised and unsupported FASD are wide, including addiction, mental health problems and disengagement with education. Children can appear bright and talkative and can appear to learn, but often forget what they have learned by the following day. They can also behave inappropriately. Because the cause of their difficult behaviour is not understood, they frustrate teachers and are often labelled as “naughty”. Sadly, another tragic consequence of unrecognised FASD, is that many go on to find themselves in <a href="http://www.cdc.gov/ncbddd/fasd/secondary-conditions.html#ref">trouble with the law</a>. </p>
<p>Early detection and intervention are important because with the right support, there is <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1475-3588.2008.00504.x/full">growing evidence</a> that people with FASD can live and work independently. But, until the UK catches up with the USA, Canada and Italy, many people with FASD will continue to suffer in silence.</p><img src="https://counter.theconversation.com/content/52835/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Penny Cook is part of a national team of academics and doctors who have been working on grant applications in the hope of gaining funding to carry out a study to determine the prevalence of FASD in the UK.</span></em></p><p class="fine-print"><em><span>Raja Mukherjee is an independent volunteer (unpaid) medical adviser to various UK charities related to FASD</span></em></p>The UK government are finally waking up to the problem of foetal alcohol spectrum disorder.Penny A. Cook, Professor, University of SalfordRaja Mukherjee, St George's, University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/492932015-11-05T19:04:35Z2015-11-05T19:04:35ZHere’s how we can stop putting Aboriginal people with disabilities in prison<p><a href="https://www.mhdcd.unsw.edu.au/">Our research</a> shows how Australia imprisons thousands of Aboriginal people with mental and cognitive disabilities each year because of a lack of understanding, and a dearth of community-based services and support. </p>
<p>It also shows what can be done about this shameful breach of human rights.</p>
<p>We have data on hundreds of Aboriginal people with mental and cognitive disabilities that tells the story of their early and regular contact with police, courts and custody. And Aboriginal researchers in our team have spoken with Aboriginal people with disabilities, their families, communities and service providers in New South Wales and the Northern Territory so we can better understand their experiences. </p>
<h2>What will make a difference</h2>
<p>Based on that research, we are recommending these principles and strategies to underpin policy reform:</p>
<p><strong>1. Self-determination</strong></p>
<p>Self-determination is key to improving the human rights and well-being of Aboriginal people with mental and cognitive disabilities. This means an <a href="https://www.humanrights.gov.au/right-self-determination">ongoing process of choice</a> on matters affecting them, their families and communities.</p>
<p>Community-led knowledge, solutions and services to respond to the over-representation of Aboriginal people with mental and cognitive disabilities in prison should be properly supported and resourced. And we must ensure the input of Aboriginal women on their needs and aspirations given their particular disadvantage and vulnerability in the criminal justice system. We also need better services for Aboriginal people in regional and remote areas. </p>
<p>Education and cultural competency for non-Aboriginal organisations and people working in this area is crucial.</p>
<p><strong>2: Person-centred support</strong></p>
<p>Person-centred support that puts Aboriginal people with mental and cognitive disabilities at the centre of their care and that’s appropriate to their culture and context is essential. People should be supported to make decisions about their own needs and recovery. </p>
<p>Disability services and the National Disability Insurance Scheme (NDIS) need an overt strategy to support Aboriginal people with disabilities in the criminal justice system. This initiative should also cover the needs of people with borderline intellectual disability and fetal alcohol syndrome disorder (FASD), who may not be recognised as having a disability but who often need targeted support so they don’t end up in prison.</p>
<p>Specialised housing, services and treatment options should be available in the community to prevent incarceration and improve well-being.</p>
<p><strong>3. A holistic and flexible approach</strong></p>
<p>A determined holistic and flexible approach to services for Aboriginal people with mental and cognitive disabilities is needed from a young age to avoid contact with the criminal justice system. Early recognition by maternal and infant health services, early childhood and school education, community health services and police is important. </p>
<p>Governments should provide positive and preventive support that allows Aboriginal children and young people with disability to develop and flourish. We need supported housing and case management options for people with cognitive impairment to help keen them out of the the criminal justice system. The <a href="https://www.portal.facs.nsw.gov.au/Guidelines/SourceDocuments/cjp_tailored_support_packages.pdf">NSW Community Justice Program</a> is a good example. It provides specialised intensive 24-hour supported accommodation to drop in support for people with an intellectual disability who have been in the criminal justice system. </p>
<p><strong>4. Integrated services</strong></p>
<p>Government and non-government services need to work in a more integrated way to improve referral, information sharing and case management, and to better support Aboriginal people with mental and cognitive disabilities.</p>
<p>Justice, Corrections and Human Services departments and non-government services should take a collaborative approach to program pathways for Aboriginal people with disabilities who need support across their sectors. All prisoners with a cognitive impairment should be referred to the public advocate of the state or territory they are in.</p>
<h2>Better practice and prevention</h2>
<p>It’s vital that Aboriginal understandings of “disability” and “impairment” underpin support for Aboriginal people with mental and cognitive disabilities in the criminal justice system. The particular experiences and perspectives of Aboriginal women should be central.</p>
<p>Better education and information on Aboriginal people with disabilities is needed for police, teachers, education support workers, lawyers, magistrates, health, corrections, disability and community service providers to help them understand and work with Aboriginal people with cognitive impairment, mental health disorders and complex support needs. </p>
<p>More resources are also needed for Aboriginal communities, families and carers so they can better support people with mental and cognitive disabilities.</p>
<p>Our data tracks the pathways of Aboriginal people with mental and cognitive disabilities into early contact with police, courts and custody largely due to a lack of appropriate health, education, disability and community services. We heard about the racism and stigma faced by Aboriginal people with disabilities that drives the cycle of over-policing, under-servicing and incarceration.</p>
<p>This predictable path is preventable. Early intervention and diversion into holistic, therapeutic, culturally responsive, local community-based services are essential. These will enable Aboriginal people with mental and cognitive disabilities to live with dignity and support in their communities.</p>
<hr>
<p><em>This is the fifth in a series of articles by this research team. Click <a href="https://theconversation.com/au/topics/aboriginal-people-with-mental-and-cognitive-disability-43089">here</a> to read more on the Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project.</em></p>
<hr>
<p><em>Ruth will be on hand for an Author Q&A between 10 and 11am AEDT on Friday November 6, 2015. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/49293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth McEntyre was the Australian Postgraduate Award Industry recipient for the IAMHDCD Project.</span></em></p><p class="fine-print"><em><span>Eileen Baldry receives funding from The Australian Research Council, FaCS NSW, Dept of Justice NSW. She is affiliated with PIAC & CRC. </span></em></p><p class="fine-print"><em><span>Ruth McCausland is Vice-President of the Board of the Community Restorative Centre.</span></em></p>The predictable path into prison for Aboriginal people with disabilities is preventable. Here are some solutions.Elizabeth McEntyre, PhD Candidate in Social Work and Criminology, UNSW SydneyEileen Baldry, Professor of Criminology, UNSW SydneyRuth McCausland, Research Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/481662015-11-01T19:10:56Z2015-11-01T19:10:56ZWhy Aboriginal people with disabilities crowd Australia’s prisons<figure><img src="https://images.theconversation.com/files/99775/original/image-20151027-18458-bfmipz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Aboriginal people with mental and cognitive disability are 'managed' by police, courts and prisons due to a lack of appropriate community-based services.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/treslola/6368127913/in/photolist-aGJjyR-aGJdTt-aGJ6bx-aGJLFi-aGJabe-aGJTYc-aGJzNH-aGJ3Ea-aGJokp-aGJszc-aGJX38-aGJter-aGJfG8-aGJRCM-aGK7Fv-aGK1mr-aGJxop-aGK5BD-aGJbZX-aGJrTg-aGJNKF-aGJEm2-aGK3g2-aGJmwn-wK7jbw-wv4JVN-wMEApR-sccPz3-srUNtf-scCv7m-wt7Bo9-vNVFM4-wtffNg-9NAsCc-wtn8Gt-rxcdBE-97tA6K-rrwjr2-scCu8s-sub3YF-wt9Dih-vNQ6oA-7BtXTi-vNKvQS-wtbpJS-vNsNGS-2tkwWA-7BtY3n-7BtYne-aGevrn">Kate Ausburn/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Australia imprisons thousands of Aboriginal people with mental and cognitive disability each year. A widespread lack of understanding – and action – underpins this shameful breach of human rights.</p>
<p>The number of people in Australian prisons recently reached an all time high of 33,791, with 27% or 9,264 of those prisoners <a href="http://www.abs.gov.au/ausstats/abs@.nsf/mf/4517.0">identifying as Aboriginal and Torres Strait Islander</a>. People with mental and cognitive disability who are poor, disadvantaged, and Aboriginal are overrepresented in this increase.</p>
<p>To clarify, mental disabilities include disorders such as depression, schizophrenia, anxiety, personality disorders and psychosis. People can experience these for a short time or throughout their lives. While cognitive disability covers impairments such as intellectual disability, acquired brain injury, dementia and fetal alcohol spectrum disorder (FASD). These are ongoing impairments in comprehension, reason, judgement, learning or memory. </p>
<h2>A predictable path</h2>
<p>A <a href="https://www.mhdcd.unsw.edu.au/sites/www.mhdcd.unsw.edu.au/files/u18/pdf/a_predictable_and_preventable_path_2Nov15.pdf">study</a> we released today shows how Aboriginal people with mental and cognitive disability are being “managed” by police, courts and prisons due to a dire lack of appropriate community-based services and support. </p>
<p>The <a href="https://www.mhdcd.unsw.edu.au/">Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project</a> draws on a unique data set of 2,731 people who’ve been imprisoned in New South Wales, which holds <a href="http://www.bocsar.nsw.gov.au/Documents/custody/Q22015Custodyreport.pdf">more than a third</a> of Australia’s prison population. A quarter of people in the data set are Indigenous. </p>
<p>Throughout this article, we use “Indigenous” to match government data collection terms, and “Aboriginal” in our study findings to reflect the preference of the communities we worked with. </p>
<p>Our study includes data from police, courts, legal aid, juvenile justice and corrective services as well as government housing, disability, health and community services. The data shows that Indigenous people experience earlier and greater contact with the criminal justice system and are more disadvantaged generally than non-Indigenous people with mental and cognitive disabilities.</p>
<p>Aboriginal researchers in our team also spoke with Aboriginal people with mental and cognitive disability, their families, communities and service providers in four sites across NSW and the Northern Territory so we could better understand their experiences.</p>
<p>We found Aboriginal people with mental and cognitive disability are forced into the criminal justice system early in life. Coming from poor and disadvantaged backgrounds, they receive little support from community and disability services or the education system. </p>
<p>These people are often seen as badly behaved or too hard to control, and left to police to manage. While this also applies to non-Indigenous people with disability from disadvantaged backgrounds, we found it’s much more serious for Indigenous people. </p>
<p>Indigenous people in the group we studied were 2.6 times more likely to have been in out-of-home care as children. </p>
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<p>Their age of first contact with police was 3.4 years younger than non-Indigenous people, and they had a higher rate of contact with police as both victim and offender. </p>
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<p>Indigenous people were 2.4 times more likely to be in juvenile justice custody than non-Indigenous people. </p>
<p>And they had higher numbers and rates of convictions and more episodes of remand in prison (unsentenced). </p>
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<p>Indigenous people had higher rates of hospital admissions and were 1.2 times more likely to have been homeless – in a group with very high rates of homelessness generally. </p>
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<p>Those with complex needs (multiple diagnoses and disability) – particularly women – were the most disadvantaged. And Indigenous people from highly disadvantaged areas, especially regional and remote areas, fared the worst.</p>
<h2>Four key drivers</h2>
<p>Our research shows four major issues underlie these shocking statistics:</p>
<p><strong>1. People don’t understand what cognitive disability is</strong></p>
<p>Families, service workers, teachers, police, lawyers and magistrates don’t understand enough about cognitive impairment. They often think cognitive impairment and mental illness are the same. People with cognitive impairment, for instance, are often dealt with under mental health laws. </p>
<p>But imprisonment has serious consequences for people with cognitive impairment. People with FASD face difficulties due to low levels of understanding and diagnosis, as do those with borderline intellectual disability, because they are not recognised as having a disability by services and may not be supported by the new National Disability Insurance Scheme (NDIS). </p>
<p><strong>2. High levels of stress in some Aboriginal communities</strong></p>
<p>Aboriginal communities are under a great deal of stress from socioeconomic disadvantage, loss, grief and trauma. This comes from generations of Aboriginal people experiencing dispossession, racism, forcible removal of children, poor education and health care, overcrowded housing, early deaths of family and community members, over-policing, and high rates of incarceration.</p>
<p><strong>3. Many Aboriginal people in the criminal justice system have ‘complex support needs’</strong> </p>
<p>Aboriginal people with more than one type of impairment or disability are <a href="http://www.lawreform.justice.nsw.gov.au/Documents/report_135_final.pdf">more likely</a> to be involved in the criminal justice system. Families and communities are overwhelmed, and services are not set up to provide the kind of specialist support needed by people who experience multiple mental and cognitive disabilities, as well as drug and alcohol dependency. </p>
<p>Different diagnoses and disorders can become meshed together and masked by each other (this is known as “complex support needs”). It’s difficult for Aboriginal people with complex support needs to get appropriate help because services often focus on only one area – mental health, or intellectual disability, or drug and alcohol rehabilitation – and also because of racism and poverty. </p>
<p><strong>4. A lack of appropriate support for Aboriginal people with mental and cognitive disability</strong></p>
<p>From a young age, Aboriginal people with mental and cognitive disability are dealt with by systems of control rather than systems of care or protection. They can face discrimination on the basis of race and disability as well as having a criminal record; feel isolated and disconnected from family and community; and have limited access to appropriate community-based support options. </p>
<p>There are very few alternatives to prison and a lack of appropriate programs in prison or after release, particularly for those from regional or remote areas. And that makes return to prison very likely.</p>
<p>Our research found police and prisons have become governments’ default way of managing this vulnerable group rather than appropriately supporting them to have a life of stability and self-worth in the community. Australia’s imprisonment and re-imprisonment of Aboriginal people with mental and cognitive disability is not only shameful, it’s entirely predictable and preventable.</p>
<p><em>This is the first in a series of articles by this research team. Click <a href="https://theconversation.com/au/topics/aboriginal-people-with-mental-and-cognitive-disability-43089">here</a> to read more on the Indigenous Australians with Mental Health Disorders and Cognitive Disability in the Criminal Justice System (IAMHDCD) Project.</em></p><img src="https://counter.theconversation.com/content/48166/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eileen Baldry receives funding from The Australian Research Council, FaCS NSW, Dept of Justice NSW. She is affiliated with PIAC & CRC.</span></em></p><p class="fine-print"><em><span>Elizabeth McEntyre was the Australian Postgraduate Award Industry recipient for the IAMHDCD Project.</span></em></p><p class="fine-print"><em><span>Ruth McCausland is Vice-President of the Board of the Community Restorative Centre.</span></em></p>Australia’s high rates of imprisonment and re-imprisonment of Aboriginal people with mental and cognitive disabilities is not only shameful, it is entirely predictable and preventable.Eileen Baldry, Professor of Criminology, UNSW SydneyElizabeth McEntyre, PhD Candidate in Social Work and Criminology, UNSW SydneyRuth McCausland, Research Fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/486592015-10-13T02:25:46Z2015-10-13T02:25:46ZYoung offenders must be screened for fetal alcohol spectrum disorders before sentencing<figure><img src="https://images.theconversation.com/files/98153/original/image-20151012-17853-8cvs0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's vital to ensure youth put behind bars have been properly assessed before sentencing.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Australia’s prison population is growing at <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4517.0%7E2014%7EMedia%20Release%7EAustralian%20prisoner%20numbers%20climb%20to%20ten%20year%20high%20(Media%20Release)%7E10023">unprecedented rates</a>. In some states Indigenous prisoners far outnumber their non-Indigenous counterparts. </p>
<p>Last year in the <a href="https://theconversation.com/state-of-imprisonment-if-locking-em-up-is-the-goal-nts-a-success-39185">Northern Territory</a>, 86% of those in prison and 96% of those in juvenile detention were Indigenous. <a href="https://theconversation.com/state-of-imprisonment-lopsided-incarceration-rates-blight-west-38986">In Western Australia</a>, Indigenous people account for only 3% of the population, but 40% of prisoners. </p>
<p>It is unacceptable to ignore the intellectual capacity of a person facing the court and it’s vital to ensure that youth put behind bars have been properly assessed before sentencing. This is particularly important for Australians affected by fetal alcohol spectrum disorders (FASD). These occur throughout society and in high levels in some Indigenous communities.</p>
<p>The capacity to <a href="http://www.ncbi.nlm.nih.gov/pubmed/26338492">screen for prenatal alcohol exposure</a> – as well as to diagnose FASD – must urgently be increased. This echoes <a href="http://www.theaustralian.com.au/business/legal-affairs/test-kids-before-courts-for-fetal-alcohol-syndrome-magistrate/story-e6frg97x-1227546353318">recent calls by Perth Children’s Court magistrate</a> Catherine Crawford for clinicians to assess children and youth before sentencing, so the court understands their cognitive limitations. </p>
<h2>Cognitive limitations</h2>
<p>Fetal alcohol spectrum disorders are a <a href="http://www.ncbi.nlm.nih.gov/pubmed/25848734">group of preventable conditions</a> resulting from exposure to alcohol in the womb. Alcohol readily crosses the mother’s placenta, entering the circulation of the developing fetus with devastating effects. </p>
<p>Significantly, it can disrupt brain development and that of other organs, causing lifelong problems. These include developmental delay, intellectual and memory impairment, as well as a range of behavioural, emotional and mental health disorders. </p>
<p>People with FASD can suffer from attention-deficit hyperactivity disorders (ADHD), communication disorders, poor impulse control, disobedience and hostility issues, and learning difficulties. </p>
<p>They often struggle to distinguish right from wrong and fail to learn from mistakes. Few with FASD will live and work independently. Many have mental health and substance misuse problems. </p>
<p>It is no surprise that <a href="http://www.ncbi.nlm.nih.gov/pubmed/15308923">many also come in contact with the law</a>. An adolescent living with a FASD in Canada or the United States, for instance, <a href="http://www.ncbi.nlm.nih.gov/pubmed/22032097">is estimated to have</a> a 19 times higher risk of incarceration than someone without a FASD.</p>
<p>Despite this, the condition remains poorly recognised and few obtain a diagnosis prior to offending. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20888044">Offenders with FASD</a> are often poor witnesses and fail to understand why they have been detained. Unable to negotiate the justice system, they are adversely influenced by others and often enter a cycle of re-offending.</p>
<h2>FASD and the justice system</h2>
<p><a href="http://www.theguardian.com/commentisfree/2014/mar/14/jailed-without-conviction-send-rosie-anne-fulton-home">Rosie Fulton</a>, a 21-year-old Aboriginal woman with FASD and significant intellectual impairment, was arrested last year after stealing and crashing a car. Declared unfit to stand trial, Rosie was sent to Western Australia’s Kalgoorlie Prison for lack of alternative accommodation. </p>
<p>She stayed in jail for 21 months with no trial or conviction. Only after her story broke, mounting pressure on the health ministers of Western Australia and the Northern Territory led to Rosie being <a href="http://www.abc.net.au/news/2014-06-25/aboriginal-woman-in-jail-without-conviction-to-be-freed/5550790">transferred</a> to supervised community accommodation close to her family in Alice Springs.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/98155/original/image-20151013-17809-10fddn7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/98155/original/image-20151013-17809-10fddn7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/98155/original/image-20151013-17809-10fddn7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/98155/original/image-20151013-17809-10fddn7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/98155/original/image-20151013-17809-10fddn7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/98155/original/image-20151013-17809-10fddn7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/98155/original/image-20151013-17809-10fddn7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Young people with a FASD often have learning difficulties.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/francisco_osorio/8425548570/in/photolist-dQx93N-fwr2cP-dYzGoR-dQx5qh-dQwVB1-dQwTi9-dQrk7x-8v4TQ-tFR8Jw-BLfMq-dQwQsw-dQxavq-dQrwZH-BM4DM-pdYzyy-rbD36X-ruXheR-aYtadR-dQwRxL-cdmjho-dQrhXV-dQriPF-p3N7f7-dQx8D7-dQwTxj-ebGSib-dQwSi9-ehTt4H-eeW2XT-dQxaYy-dQrheM-wEzWQQ-dQxcTf-dQrECB-6TJzFk-dQrEaM-ebBe6z-dQrF8P-dQwR1b-dQru36-dQrv3r-dQxbx3-eeW1NR-dQrkCr-aYtadZ-6fnd68-azyH5Z-aYtae2-dQxbL5-dQrqZn">Francisco Osorio/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In Australia, we don’t know how many people deemed “unfit to plead” are in prison and how many have cognitive impairment, as we lack recent data regarding rates of FASD in prisons. US studies suggest up to 60% of young people with FASD will at <a href="http://www.ncbi.nlm.nih.gov/pubmed/15308923">some time enter the juvenile justice system</a>. </p>
<p>Another study, conducted in a forensic mental health facility in Canada, showed <a href="http://www.ncbi.nlm.nih.gov/pubmed/10533996">23% of resident youth</a> had one type of FASD. This figure <a href="http://www.ncbi.nlm.nih.gov/pubmed/25693629">may be higher in vulnerable Australian populations</a>, particularly in some remote regions where alcohol use in pregnancy is prevalent. </p>
<p>The economic impact of incarcerating people with FASD is huge. In Canada, <a href="http://www.ncbi.nlm.nih.gov/pubmed/25846557">the direct cost to the correctional system</a> between 2011 and 2012 was CAD$17.5 million for youth and CAD$356.2 million for adults. </p>
<h2>Screening for FASD</h2>
<p>Diagnosing FASD is a challenge because as children get older, a firm history of prenatal alcohol exposure may be elusive. With age, the characteristic facial features (small eye openings, a thin upper lip and flat philtrum, the area between the upper lip and base of the nose) of fetal alcohol syndrome – a subset of FASD – diminish, and growth deficits correct.</p>
<p>Thorough assessment by a physician, a psychologist and, if necessary, allied health professionals, can identify impairments required for a FASD diagnosis, whether fetal alcohol syndrome or a neuro-developmental disorder associated with prenatal alcohol exposure. Such impairments can be in IQ, communication, memory, motor and executive function, and other areas.</p>
<p>In Canada, youth probation officers are using a <a href="http://www.asantecentre.org/">tool for screening young offenders for FASD</a>, and identifying the need for referral and assessment. </p>
<p>Another tool for health professionals with accompanying guidelines for assessing and diagnosing people with FASD is <a href="http://www.ncbi.nlm.nih.gov/pubmed/24083778">being developed in Australia</a>. This will standardise the diagnostic approach.</p>
<p>Tools such as these are necessary to increase screening and diagnostic capacity in the justice and health systems. If a diagnosis is known, the associated behavioural and cognitive deficits can be taken into account when considering the reliability of evidence given by an offender, the supervision required in detention, and the sentence. </p>
<h2>Appropriate care</h2>
<p>There has been a <a href="http://www.ncbi.nlm.nih.gov/pubmed/20888044">call for better legal support</a> for people with vulnerabilities in their journey through the criminal justice system. Consideration should be given to the <a href="http://www.ncbi.nlm.nih.gov/pubmed/23228502">defence of diminished responsibility</a> in conditions such as FASD. </p>
<p>And alternative models of care need to be found to avoid imprisonment of those unable to plead. As identified in the case of Rosie Fulton, this poses a significant challenge, particularly in remote Australia where alternative accommodation is not readily available and would be costly to establish. </p>
<p>But prison is far more costly. In Canada, the justice system accounts for <a href="http://www.ncbi.nlm.nih.gov/pubmed/26072470">40% of the total costs of FASD</a> (including health and education). And Australia’s <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Legal_and_Constitutional_Affairs/Completed_inquiries/2010-13/justicereinvestment/report/index">Senate inquiry on justice reinvestment</a> heard that the estimated cost of detaining a juvenile offender in New South Wales in 2010–11 was much higher ($A652 per day) than the cost of supervision in the community ($A16.73 per day).</p>
<p>To end the cycle of re-offending, we urgently need evidence-based strategies to ensure offenders with FASD are recognised early and receive the care they deserve.</p><img src="https://counter.theconversation.com/content/48659/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Elliott receives funding from the National Health and Medical Research Council of Australia and the Australian Government for research into Fetal Alcohol Spectrum Disorders.
She is a Member of the Board of charities Cure Kids Australia and the Institute for Creative Health and a member of the Medical Advisory Committee of the Steve Waugh Foundation. </span></em></p>Many young people in jail suffer fetal alcohol spectrum disorders. Diagnosing these before sentencing will establish the most appropriate path for these vulnerable offenders, which often isn’t jail.Elizabeth Elliott, Professor of Paediatrics & Child Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.