By Angela Hart
Children who grow up in foster care or are adopted from orphanages are more at risk for fetal alcohol syndrome because there is a higher probability that their mothers consumed alcohol during pregnancy. An international study published Monday strongly recommends that infants and adolescents in these child welfare settings be tested for the disorder.
"It is imperative that screening be implemented in these at-risk populations," reported the authors of the study, "Prevalence of Fetal Alcohol Spectrum Disorders in Child Care Setting." The researchers conducted a meta-analysis, where they pooled data from past studies.
Fetal alcohol syndrome can cause a cascade of problems, including physical deformities, developmental delay, learning disorders and behavior problems.
Svetlana Popova of the University of Toronto said she and three other researchers collected international data from peer-reviewed journals, government reports and books. They found that 6 percent of children who live in foster homes or similar care settings have fetal alcohol syndrome. This rate is approximately nine to 60 times higher than that in the general population internationally and up to 30 times higher than the prevalence of the disorder in the general population in the U.S., which is between 0.2 and 0.7 percent, Popova said in an interview.
"Our research team has been studying the disorder for years," Popova said. "We hope the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure."
Though fetal alcohol syndrome is preventable, it is difficult to diagnose because health care providers must understand how often and how much alcohol the mother drank during pregnancy, and at which stages, according to experts who study the disorder. Even more challenging is that alcohol affects children differently — problems range from facial deformities to brain damage that can manifest itself in cognitive impairments, difficulty learning, and inability to cope in social settings.
Tom Donaldson, president of the National Organization on Fetal Alcohol Syndrome, said screening for the disorder would have huge benefits both to the person who has it and to society.
"Screening would be very important in many systems of care because when you screen, you can then diagnose, and then you can develop a care plan and get somebody on a path of reaching their full potential," Donaldson said.
But he cautioned that information needed to identify the disorder is often hard to come by.
"You need the alcohol usage history from the mother," he said. And when so many affected children "are in foster care or adoptive care — they're not with their biological parents — that can sometimes can be hard to obtain," he said.
Monday was also International Fetal Alcohol Syndrome Awareness Day, established in 1999 in an attempt to draw international attention to the importance of abstaining from drinking alcohol during pregnancy, said experts in the field.
The awareness day "is an important reminder that prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States," said the National Institutes of Health in a release. "Almost 40 years have passed since we recognized that drinking during pregnancy can result in a wide range of disabilities for children, of which Fetal Alcohol Syndrome is the most severe."
Sarah Mattson, an expert in fetal alcohol syndrome at San Diego State University, said the disorder has remained a severe public health problem since its initial identification in 1973.
"Mixed messages in the media and a general lack of information about the disorder in the general population are at least part of the reason that it is so prevalent," Mattson said.
Advocates say the leading recommendation of the study in the journal "Pediatrics" — early detection, especially in foster care settings -- can lead to wider public awareness and improved health for those affected.
"Screening can lead to better coordination between agencies, for example, between schools, between health care agencies and in the actual foster homes," said Mike Odeh, of Children Now, an advocacy group. "We know by definition, children in the welfare system are by definition more vulnerable, so it's no surprise that there is higher prevalence of the disorder in those areas. We need to focus on early identification, but also look at how our systems are set up to coordinate their care."