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Prevalence of fetal alcohol spectrum disorder in Greater Manchester, UK: An active case ascertainment study
Robyn McCarthy1, Raja A S Mukherjee1,2, Kate M Fleming3
1School of Health and Society, University of Salford, Salford, UK.
Insights
Fetal alcohol spectrum disorders (FASD) are common in UK primary schools, with an estimated prevalence of 1.8% to 3.6%. Many affected children
Area of Science:
- Neuroscience
- Public Health
- Pediatrics
Background:
- High levels of prenatal alcohol exposure in the UK.
- Limited evidence on the prevalence of Fetal Alcohol Spectrum Disorders (FASD).
Purpose of the Study:
- To investigate the prevalence of FASD in a sample of UK primary school children.
- To identify undiagnosed cases of FASD.
Main Methods:
- A 2-phase active case ascertainment study in 3 mainstream primary schools in Greater Manchester, UK.
- Screening of 8-9-year-old children for FASD risk factors.
- Gold standard FASD assessment including medical history, facial dysmorphology, neurological impairment, executive function, and behavioral difficulties for screen-positive children.
Main Results:
- Out of 220 children, 12% screened positive for FASD risk.
- 4 children (1.8%) were diagnosed with FASD, and 4 more (1.8%) were possible FASD cases.
- None of the identified children had a prior developmental diagnosis.
Conclusions:
- FASD is prevalent in the studied primary school population.
- Most children with FASD had unidentified needs.
- A larger, definitive study with random sampling is recommended to determine population prevalence.
Background:
Despite high levels of prenatal alcohol exposure in the UK, evidence on the prevalence of fetal alcohol spectrum disorders (FASD) is lacking. This paper reports on FASD prevalence in a small sample of children in primary school.
Methods:
A 2-phase active case ascertainment study was conducted in 3 mainstream primary schools in Greater Manchester, UK. Schools were located in areas that ranged from relatively deprived to relatively affluent. Initial screening of children aged 8-9 years used prespecified criteria for elevated FASD risk (small for age; special educational needs; currently/previously in care; significant social/emotional/mental health symptoms). Screen-positive children were invited for detailed ascertainment of FASD using gold standard measures that included medical history, facial dysmorphology, neurological impairment, executive function, and behavioral difficulties.
Results:
Of 220 eligible children, 50 (23%) screened positive and 12% (26/220) proceeded to Phase 2 assessment. Twenty had a developmental disorder, of whom 4 had FASD and 4 were assessed as possible FASD. The crude prevalence rate of FASD in these schools was 1.8% (95% CI: 1.0%, 3.4%) and when including possible cases was 3.6% (2.1%, 6.3%). None of these children had previously been identified with a developmental diagnosis.
Conclusions:
FASD was found to be common in these schools and most of these children's needs had not previously been identified. A larger, more definitive study that uses a random sampling technique stratified by deprivation level to select schools is needed to make inferences regarding the population prevalence of FASD.
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