Born with a craving for alcohol


Studies show in-utero alcohol consumption can cause ADHD, autism and other neurological conditions, writes FIONA GARTLAND

WOMEN IN Ireland who drink while pregnant are creating children three times more likely to crave alcohol, according to a leading specialist in the field.

Studies also show in-utero alcohol consumption can cause attention deficit hyperactivity disorder (ADHD), autism and other neurological conditions.

Foetal alcohol spectrum disorders (FASDs), which include foetal alcohol syndrome (FAS), alcohol-related birth defects and alcohol-related neurodevelopmental disorder (ARND), are thought to affect about 700 babies born here every year.

The disorders can be trans-generational, passing down through one generation after another in some families.

They are the most common cause of preventable intellectual disability, yet they are not notifiable, and there is no clear, official message given to women in Ireland that alcohol during pregnancy can cause these problems.

In a study in Dublin’s Coombe Hospital published in 2006, 82 per cent of women continued drinking while pregnant – almost eight times as many as women in the US, where FASDs are notifiable and drinks carry a warning label.

The National Substance Misuse Strategy Steering Group, set up by the Government last year, is expected to consider such issues, but has yet to report.

So why are we so reluctant to face up to the link between in-utero alcohol consumption and FASDs?

Could it be that we balk at the task of telling women the alcohol they consumed while pregnant may have been the cause of their child’s condition?

FAS was first identified in 1968 as a condition that affected the growth and facial features of children who were exposed to alcohol before birth. Babies had specific facial features such as a low nasal bridge, a thin upper lip, flat mid-face and an indistinct philtrum, the groove that runs from the top of the lip to the nose.

ARND was later coined to describe brain dysfunctions associated with pre-natal alcohol exposure in children without facial signs, and in 2000, FASDs became the umbrella term to describe all the effects of alcohol exposure before birth.

Problems associated with the disorders include poor growth, decreased muscle tone and poor co-ordination, delayed development and significant functional problems in thinking, speech and movement as well as behaviour problems.

Dr Kieran O’Malley, consultant psychiatrist at Our Lady’s Hospital for Sick Children in Crumlin, says it is time we faced up to the problem.

“It seems we are 20 years behind North America with FASDs in Ireland, not dissimilar to how we dealt with child abuse. It is a socio-cultural issue,” he says. “The truth is there are no safe amounts of alcohol in pregnancy.”

The doctor, who has worked in the US and Canada and opened the first foetal alcohol clinic in Ireland in 2009, says he has seen children in his Irish clinic who crave alcohol.

“If a foetus is exposed to alcohol, it chemically increases its craving. I have seen six and seven year olds who steal cough medicines because they can smell it. They go to it like bees to honey.”

And he has been involved with three and four generations of families with the condition. “I’ve personally seen at least 100 trans-generational sufferers in Ireland. One woman told me she didn’t think much about how her child looked; he looked the same as her brother.”

Trans-generational FASDs are a major unrecognised public health problem, he says. Teenagers with FASDs are more prone to binge drink and binge-drinking teenagers get pregnant more easily and create “the next generation of foetal alcohol kids”.

The most common presentation of FASDs is ADHD, O’Malley says, but a certain group on the autistic spectrum can also be attributed to the disorders. Because FASDs are not notifiable, there are problems with how cases are processed.

“The condition is hidden under a complex of ADHD and autistic spectrum or Asperger’s disorder to get services,” he says.

“Officially, there are no cases of FASDs in Ireland because they are not notifiable; it is a classic hidden disability.”

He says if a disability is hidden, teachers don’t know how to teach children with it and can’t help them.

“In North America, they got rid of the denying and started notifying. They now have the services in place,” he says.

He believes it is essential for FASDs to become notifiable in Ireland. Giving the disorders that status would mean numbers could be properly quantified and proper services could be provided. Early diagnosis could also help alleviate the disorders.

“They can be helped if diagnosed under three when the brain is still plastic and so amenable to motor or sensory integration physical therapies and maybe even nutritional therapies,” he says.

Michele Savage, founder of support organisation FASD Ireland, also wants to see the disorders become notifiable.

“If you don’t have the statistics, you don’t have epidemiology, and if you don’t have that, you don’t have services,” she says.

Warning labels on alcoholic drinks are also essential in her view. “Since 1989, the US has had warning labels on alcohol and there has been a huge drop in alcohol consumption by pregnant women to 10-12 per cent,” she says.

“This is not about policing women’s pregnancy, but we wish women knew that if they are pregnant alcohol won’t help their baby.”

The organisation has always tried to steer away from a “Thou shalt not do it” stance.

“We abhor people who tell women what they should do, but we believe women should be given all of the information, so that they can make a choice.”

She does not believe the message about alcohol should be softened to protect the feelings of women whose children have been diagnosed with neuro-developmental conditions.

But she doesn’t think the blame game should be played either. She says the organisation has come across women in distress whose children have been newly diagnosed.

“We say, ‘This is not your fault; which doctor told you about alcohol when you were pregnant?’”

World FASD Day is on September 9th


Because Susie didn’t have the facial features of a child with FAS, no one suspected she might have difficulties.

Her mother didn’t drink alcohol for the first three months of pregnancy, but afterwards had a good night out once a week. In primary school, Susie was labelled a “dolly daydreamer” and needed constant help with maths. She was always leaving something at home that was needed in school, and vice versa.

When she was 11, following concerns from her mother, Susie was referred to a specialist and diagnosed as having ARND. The parts of her brain responsible for attention and impulsivity, and working memory and logical reasoning were damaged.

She also showed signs of having sensory integration issues, so that she lacked physical boundaries and could be overwhelmed by sounds, smells and visual stimuli.

Sonya: early diagnosis

Sonya was born two weeks early and was diagnosed at birth as having FAS because of her facial features. Her diagnosis meant she received early intervention and so later managed to get on well at her special school. Though she had ADHD and some autistic traits, she was less at risk of having secondary disabilities associated with her condition, such as anxiety and mood disorders, because of her early diagnosis.