International FASD Awareness Day: Curiosity, Understanding and FASD
Every year on the 9th September, International FASD Awareness Day shines a spotlight on a condition that remains widely misunderstood and often overlooked.
For those of us working with children in care, understanding Fetal Alcohol Spectrum Disorder (FASD) can make a significant difference to how we understand, support and advocate for the children we work alongside.
The date itself is significant. International FASD Awareness Day takes place on the ninth day of the ninth month to represent the nine months of pregnancy and to raise awareness of the importance of avoiding alcohol during pregnancy.
Fetal Alcohol Spectrum Disorder (FASD) is a lifelong neurodevelopmental condition caused by prenatal alcohol exposure. Alcohol can affect the development of all cells and organs, but the brain is particularly vulnerable. It can affect memory, learning, emotional regulation, impulse control, social understanding and everyday functioning.
No two children with FASD will present in exactly the same way. One of the biggest misconceptions is that it always comes with obvious physical characteristics. In reality, most individuals with FASD do not have visible features, meaning their difficulties can often be misunderstood or attributed solely to trauma, attachment difficulties, ADHD, autism, or challenging behaviour.
Although awareness of FASD remains relatively low, it is not a rare condition. Research suggests that around 2-4% of children in the general UK population may be affected, with rates thought to be significantly higher amongst children in care. The DHSC FASD Health Needs Assessment (2021) quotes a study that showed 27% of children in care in Peterborough had FASD and that 75% of those adopted were exposed to alcohol in the womb (Gregory, 2015).
National FASD estimates that, of the more than 100,000 children in care across the UK, around 29,000 may be living with FASD, with many remaining undiagnosed. The organisation also highlights the increasing number of children presenting with complex behavioural and developmental needs linked to prenatal alcohol exposure, reinforcing the importance of improving awareness and understanding of FASD across social care, health and education services.
Children with FASD may struggle to remember instructions, manage emotions, understand consequences, learn from experiences or cope with everyday demands. They may appear able to do something one day but not the next. Without an understanding of the underlying reasons for these difficulties, behaviours can easily be misinterpreted.
Understanding FASD aligns closely with trauma-informed and therapeutic practice. It encourages us to remain curious, look beyond behaviour and consider what might be influencing a child's experiences and needs.
Social workers are not expected to diagnose FASD, but they can play a key role in recognising potential indicators, gathering historical information and advocating for appropriate assessments and support.
If FASD is a possibility, it may be helpful to:
- Review the child's history and chronology for information about prenatal alcohol exposure.
- Ensure any known information about prenatal alcohol exposure is clearly recorded, as this may be important for future assessment and support.
- Consider what assessments have already been completed and whether they fully explain the child's presentation and needs.
- Consider whether existing diagnoses such as ADHD or autism fully explain a child's needs, or whether FASD may also warrant exploration.
- Speak with wider family members, where appropriate, to better understand the child's early history.
- Gather observations from carers, schools and other professionals.
- Consider that within a sibling group, children can be affected differently. If one child is suspected of having FASD, all siblings should be assessed or noted for follow up. If one child has FASD then there is a stronger possibility that others will have it too.
- Discuss concerns with health professionals such as the child's GP, LAC nurse or paediatrician.
- Consider whether further assessment would help build a fuller understanding of the child's strengths and needs i.e. cognitive assessment, speech and language, executive functioning skills and physical health reports.
- Remember that support and adaptations can begin before a formal diagnosis is in place.
Most importantly, remain curious. FASD can sit alongside trauma, attachment difficulties and other neurodevelopmental differences. While trauma-informed practice remains essential, it is important not to assume that trauma alone explains a child's presentation. Keeping an open mind to the possibility of FASD can help us develop a more complete understanding of a child's needs.
Research from the University of Salford suggests that children who have experienced both prenatal alcohol exposure and trauma may present in very similar ways to children with prenatal alcohol exposure alone. The findings indicate that the challenges experienced by children with both exposures may be driven more by the impact of prenatal alcohol exposure than by trauma itself. This highlights the importance of considering FASD when working with children whose difficulties are often viewed solely through a trauma lens and reminds us that approaches specifically designed for FASD may sometimes be more effective than trauma-based interventions alone Salford Study: Prenatal Alcohol Exposure & Childhood Trauma.
At The DECC, we are committed to continually developing our understanding of the complex needs of the children and young people we support. By increasing awareness of FASD, we can help ensure that children receive the compassion, understanding and tailored support they deserve.
Whether you're looking to learn more about FASD, access training, or find support for a child or young person, here is a list of starting points:
National FASD: https://nationalfasd.org.uk/
The UK's leading organisation dedicated to raising awareness of FASD and improving support for individuals, families and professionals.
Me & My FASD: https://fasd.me/
A child-friendly website designed to help children and young people understand FASD, recognise their strengths, hear from others with lived experience and learn more about how their brains work.
Kinship: What is FASD? https://kinship.org.uk/support-and-advice/advice-and-information/fetal-alcohol-spectrum-disorder/
A clear and accessible guide explaining what FASD is, how it may present in children and young people, and practical advice for carers and professionals.
Understanding Fetal Alcohol Spectrum Disorder (FASD) Online Workshop
A free online workshop delivered through Kinship and facilitated by the National Organisation for FASD: https://kinship.org.uk/support-and-advice/training-and-events/workshops/fasd-workshop-20260909/
Rainbow Parent Carer Forum (Midlands): https://www.rainbowpcf.org.uk/fasd
Information, resources and peer support relating to FASD for families and carers.
FASD UK Alliance and Peer Support Networks: FASD UK Alliance – United Together for Social Change
An independent coalition of groups across the UK set up by parents, carers and guardians.
The Fostering Network: Seeking Support for Children and Young People with FASD in the UK Seeking support for children and young people with FASD in the UK
This is a blog written by Dr Raja Mukherjee and Dr Alexandra Carlisle offering ideas that are drawn from research, clinical experience, and people reporting what they find helpful supporting someone with FASD.
Salford Public Health, The combined effects of prenatal alcohol exposure and childhood trauma: Findings from a four year research project at the University of Salford: Salford Study: Prenatal Alcohol Exposure & Childhood Trauma
National FASD, Foster Carers Need Information about FASD: https://nationalfasd.org.uk/learn-more/wellbeing/supporting-a-loved-one/all-shapes-of-families/foster-carers/
Insight from Brian Roberts who have been a Local Authority Foster Carer with his wife for over 25 years. Brian shares factors that can be opportunities for a child who is affected by FASD.
Raja and Neil's FASD book club - National FASD
Two of the UK's leading FASD experts have made a book for other doctors about FASD and you can watch YouTube sessions taking you through different chapters.