Pregnancy Working With Families

Identifying Fetal Alcohol Spectrum Disorders in practice with families

Published: 03/12/2019

Author: Martin Clarke

I worked as a frontline social worker in child protection for 26 years and it was not until 2009 that I had heard of Fetal Alcohol Spectrum Disorder (FASD). Even then, if I had not had a personal interest in the topic, I doubt it would have made a major change to my practice.

I was committed to seeing behaviour through an ‘attachment prism’ and looking at the impact of trauma on the child. I was focused on parents – whether their care was ‘not good enough’, and trying to help them improve their parenting, believing that this was at the heart of the issue. I never thought about whether or not alcohol, consumed by the birth mother during pregnancy, might be playing a part. And I believe many other professionals, be it teacher, police officer, child and adolescent mental health (CAMHS) worker, senior manager, nursery worker etc. may not have considered it either.

My experience of delivering FASDs training to professionals suggests there continues to be widespread ignorance of this condition. Recent research (McQuire, 2019) has suggested that the prevalence of FASDs is actually far greater than we had previously estimated. Her research (based on a cohort of 13,500 children born in 1991/92) would suggest that at least 6% of the whole population may be FASDs affected, but that it could even be as high as 17%, nearly a fifth of the whole population. An amazing statistic for a condition that is so little recognised.

We also know that the prevalence of FASDs for children in the care system are going to be far greater than for the general population, as many of them come from households that have domestic violence, substance misuse and other alcohol related issues present.

Also, many people who are aware of the condition are really only aware of Fetal Alcohol Syndrome (FAS), a condition that has visible features, yet affects only 10% of the children on the spectrum. The remaining 90% will have no visible features, will look, to use a word, ‘normal’, yet they may still have neurological damage that will affect their emotional and behavioural presentation. If we are not aware of FASDs, we may view them as ‘naughty children’ or as the products of ‘poor parenting’ and take actions accordingly or we will seek to explain their issues through either trauma or attachment histories.

Everyone working with children and families should be aware of FASDs, so that we can consider it at the earliest possible opportunity when making assessments. We can then ensure that we provide the right strategies and do not embark on alternative treatment routes, which may be costly, time-consuming, false expectation raising or even potentially harmful. For fetally affected children, ignorance of the condition can lead to professionals attributing their behaviour and presentation to other conditions (notably ADHD or autism) resulting in them potentially being ‘treated’ or medicated inappropriately.

So what do we need to do? There are several strands to this simple question, but a key word is ‘education’. We need to:

  • Educate everyone about the dangers of drinking whilst pregnant.
  • Educate in particular anyone contemplating having a baby about the additional risks posed by alcohol consumption.
  • Educate all professionals about the impact of alcohol, this includes, but is not limited to:
    • social workers
    • teachers
    • midwives and health visitors
    • police officers
    • youth offending teams
    • mental health services
    • judges
    • nursery workers
    • policy makers.
  • Educate the public, so that we remove the blame and stigma that parents may face.
  • Educate the publix, so that as a society we are more tolerant and understanding of children and adults who are affected FASDs.

Martin Clarke

Martin Clarke is the Director of Performance Support at the largest fostering and adoption charity in the UK. TACT are Partners of Research in Practice. Martin was awarded the silver Link Officer of the Year award at our Link Officers' Annual Meeting.


McQuire, C., (2019) ‘Screening prevalence of fetal alcohol spectrum disorders in a region of the United Kingdom: A population-based birth-cohort study’. Preventative Medicine 118, 344-351. Available online: