Why practitioners in children’s social care need to ‘Think FASD’ 

A child or young person with FASD can thrive when they are understood, their strengths are recognised, their needs are met and they are appropriately supported. However, despite FASD being more prevalent than autism, it is vastly underdiagnosed (McCarthy et al., 2021). Early diagnosis tends to lead to better outcomes for children with FASD. 

Practitioners can play a key role in confirming prenatal alcohol exposure (PAE), crucial for diagnosis. 

About FASD 

• FASD is a spectrum of physical, cognitive, and behavioural differences due to prenatal alcohol exposure (PAE). 
• Diagnosis requires evidence of significant differences in at least three neurodevelopmental areas such as executive function, memory, emotional regulation, cognition, attention, language, motor skills and adaptive behaviour. 
• Physical signs may include facial differences, though these occur in fewer than 10% of cases. 
• Each individual is affected differently—FASD is as unique as a fingerprint. 
• Under-recognition of FASD means children with the condition are often misdiagnosed (e.g. with ADHD). 

Alcohol use in pregnancy 

• While alcohol use at any stage of pregnancy is a risk, there are critical periods where alcohol has a more serious effect on the fetus than other times. The exact timing of these critical periods, however, remains unclear (Nykjaer et al., 2014; Clarren & Cook, 2018). 
• Current guidance states that there is no safe level of alcohol during pregnancy (Chief Medical Officers, 2016). 
• Yet alcohol use is common and socially normalised in the UK. Nearly 80% of pregnant people report drinking in the first trimester (Nykjaer et al., 2014). 
• Reasons people drink during pregnancy include: lack of awareness of affects, misinformation, stress, trauma, addiction, or unplanned pregnancy. 

Key messages for practice with birth parents 

• FASD is preventable and should be considered in all social work assessments. 
• When talking about alcohol use with parents, adopt a shame-sensitive and non-judgemental approach. 
• Given the widespread consumption of alcohol in pregnancy, the reasons for this, and the under-reporting, practitioners should remain curious about what has been recorded previously. It may reflect an inaccurate or incomplete picture. 
• It’s important to reflect on bias in assessing parental behaviour, including beliefs about parental alcohol use and especially considering class and cultural factors. 

Supporting children who have or may have FASD 

• Strategies practitioners can use when working with children and young people with FASD are: 
• Adjusting communication to developmental levels. 
• Recognising when a person’s behaviour is caused by brain differences rather than being intentional. Better understanding can prevent unfair and ineffective care, where the child or young person is misconstrued as ‘naughty’, for example.
• Avoiding punitive behaviour strategies as these may be ineffective, unfair and may be harmful to the child. 

Provide strengths-based support: 

• Focus on abilities, interests and strengths of the child. 
• Collaborate with the child and young person to leverage their strengths and address challenges they face. 
• Utilise environments and routines that support success. 
• Celebrate progress and reinforce identity and belonging. 

Supporting diagnosis and care plans 

Although diagnosis is medical, social care practitioners can contribute significantly by: 

• Considering FASD when children show signs of neurodevelopmental differences, especially where there's a history of prenatal alcohol exposure. 
• Sharing observations. 
• Recording confirmed alcohol exposure. 
• Contributing to multi-agency care planning. 

Working with families 

• Parents and caregivers often feel unsupported and blamed. 
• Practitioners should provide emotional containment, advocacy, and clear, consistent information. 

Transitioning to adulthood 

• Without appropriate support, many adults with FASD face difficulties in employment, housing, and relationships, and are overrepresented in homelessness and the criminal justice system. 
• Early preparation for adulthood, including reassessment of neurodevelopmental strengths/ challenges as well as support needs, is vital. 
• An extension of care, such as Staying Put (or When I’m Ready in Wales) or Staying Close, for young people transitioning to adulthood could provide better levels of support.  

Download the briefing for practical tools and reflections 

• Practice principles illustrate how child and family practitioners can support children and young people. 
• Reflection prompts are included to stimulate curiosity and to assist in ‘thinking FASD’ going forward. 
• Videos and podcasts where you can hear insights from children and young people with FASD as well as a birth mother’s perspective. 
• Signposting to sources of support and guidance. 

See publication for references.