Challenges in Accurately Assessing Prenatal Alcohol Exposure in a Study of Fetal Alcohol Spectrum Disorder in a Youth Detention Center

Jacinta Freeman; Carmen Condon; Sharynne Hamilton; Raewyn C Mutch; Carol Bower; Rochelle E Watkins

doi:10.1111/acer.13926

Challenges in Accurately Assessing Prenatal Alcohol Exposure in a Study of Fetal Alcohol Spectrum Disorder in a Youth Detention Center

Alcohol Clin Exp Res. 2019 Feb;43(2):309-316. doi: 10.1111/acer.13926. Epub 2018 Dec 24.

Authors

Jacinta Freeman¹, Carmen Condon¹, Sharynne Hamilton^{1

2}, Raewyn C Mutch^{1

2

3

4}, Carol Bower¹, Rochelle E Watkins¹

Affiliations

¹ Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
² School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
³ School of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Western Australia, Australia.
⁴ Child and Adolescent Health Service, Department of Health Western Australia, Perth, Western Australia, Australia.

Abstract

Background: Prenatal alcohol exposure (PAE) can result in permanent disability, including physical, neurodevelopmental, and cognitive impairments, known as fetal alcohol spectrum disorder (FASD). Individuals with FASD are more likely to engage with the law, including being placed in detention, than individuals without FASD. Young people who were sentenced to detention participated in a FASD prevalence study in Western Australia. The diagnosis of FASD requires a multidisciplinary assessment and confirmation of maternal alcohol consumption during pregnancy. Obtaining accurate assessment of PAE for young people participating in the study was challenging.

Methods: An interview with the birth mother or other responsible adult for young people sentenced to detention in Western Australia was conducted as part of the FASD assessment. The Alcohol Use Disorders Identification Test consumption subset (AUDIT-C), other relevant questions, and documentary evidence were used to assess PAE. PAE was categorized according to the Australian Guide to the Diagnosis of FASD: no PAE reported, confirmed or confirmed high-risk, or unknown.

Results: Among the 101 participants, information on PAE was unable to be obtained for 13 (13%) young people. Of the remaining 88 participants with information of PAE, 41 reported no PAE and 47 had confirmed PAE.

Conclusions: Accurately assessing prenatal alcohol consumption is challenging in any setting, but it is exceptionally challenging when assessed 13 to 17 years retrospectively as part of a FASD assessment for a young person sentenced to detention. Recording and recoding detailed qualitative responses was required to provide an accurate assessment of PAE using the AUDIT-C. Standardized recording of PAE in antenatal and birth records would facilitate later assessments for FASD and provide opportunities for advice and support for women who continue to drink during pregnancy.

Keywords: AUDIT-C; Assessing; Challenges; Fetal Alcohol Spectrum Disorder; Prenatal Alcohol Exposure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Alcohol Drinking / adverse effects
Alcohol Drinking / epidemiology*
Child
Data Accuracy*
Female
Fetal Alcohol Spectrum Disorders / diagnosis*
Humans
Juvenile Delinquency
Male
Mothers
Pregnancy
Prenatal Exposure Delayed Effects / diagnosis*
Western Australia / epidemiology

Grants and funding

#1072072/National Health and Medical Research Council/International