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October 20, 2010

Re: The tragedy of alcohol related disorders

Bruce Ritchie

Thank you for Reuel Amdur’s article “The tragedy of alcohol-related disorders.” It was well written but there are a couple of points that need to be clarified concerning Fetal Alcohol Spectrum Disorders.

He wrote: “About one per cent of Canadians suffer from fetal alcohol syndrome (FAS) or the milder FASD, which lacks some or all of the physical features of FAS. That is, many people with FASD appear completely normal.”

First, FASD (Fetal Alcohol Spectrum Disorders) is an umbrella term that describes the spectrum of disorders caused when a pregnant woman drinks beverage alcohol; FAS (Fetal Alcohol Syndrome) describes children with specific facial features. These are determined on or about the 20th day of gestation, so if the mother were not drinking at that time, a child’s facial features would be well within the “normal” range. However, the neurological damage from FASD can be just as severe as with those with FAS facial features.

In Canada, children who do not show the facial features of FAS are referred to as having ARND, Alcohol Related Neurodevelopmental Disorder. In the U.S., the term used is FAE, Fetal Alcohol Effects. ARND/FAE are no less serious than FAS. MRI studies show qualitatively no difference between FAS and ARND/FAE. However, the long-term consequences of ARND/FAE can be more serious than FAS. A “normal” looking child is less likely to be diagnosed at a young age, and is consequently at much higher risk of developing secondary disabilities that could have been prevented by early diagnosis.

Second, the one percent incidence number is a serious error based on five very old studies on small, remote First Nations communities that were done well before Canadian diagnostic criteria were set and current diagnostic tools were available. The authors of those original studies stated that their numbers should not be applied to any other communities. When the Canadian diagnostic criteria were set, these authors wrote in the Canadian Medical Association Journal in March 2005:

“There are no national statistics on the rates of FASD in Canada, although studies have estimated its prevalence in small populations. In an isolated Aboriginal community in British Columbia, FASD prevalence was 190 per 1000 live births. In northeastern Manitoba, an incidence of about 7.2 per 1000 live births was found. In another Manitoba study in a First Nations community, the prevalence of FAS and partial FAS was estimated to be 55-101 per 1000. In their survey, [Kwadwo] Asante and [Joyce] Nelms-Matzke estimated the rate of FAS and related effects at 46 per 1000 native Canadian children in the Yukon and 25 per 1000 in northern British Columbia. Based on referrals to a diagnostic clinic in Saskatchewan, the rate of FAS was estimated at 0.589 per 1000 live births in 1988-1992 and 0.515 per 1000 in 1973-1977. However, none of these data should be generalized to other communities, other populations or the Canadian population in general.”

A more accurate estimate of FASD incidence in the general Canadian population would be about 12 per cent. Special Education criteria are very strict and it is not until a student comes to the attention of teachers and others because of significant behavioural and/or performance issues that formal identification may occur. Many times the first identification occurs when the individual is before the courts.

Bruce Ritchie is the moderator of Faslink Fetal Alcohol Disorders Society.

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