Whose problem is it anyway?
By Martin Fisher, social psychologist, FASfacts
Martin Fisher
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In South Africa, alcohol has become a socio-economic issue, woven into the very fabric of our social thinking, economic transactions and planning for the future health of our developing society. When used with care and responsibility, its presence is benign and often pleasurable. When used without consciousness, it becomes a personal and social scourge.
A Foetal Alcohol Syndrome (FAS) child is every-one’s child. The emotional cost of raising a FAS child is huge, the educational cost in time and effort is enormous, and social dislocation is massive. The presence of an adolescent with FAS, manifesting in lack of impulse control, is a challenge to a community. FAS patients’ tendency to be inconsiderate with self-gratifying actions, such as lying, stealing, unwanted pregnancies, substance abuse and crime, makes their presence unwelcome. The costs of controlling and the supervision of a FAS child or teenager is something no community can afford.
What has surfaced as a result of FAS programmes is that prevention is not just a matter of dispensing information. Until people feel strongly about something, they do very little to change their behaviour. Creating awareness through knowledge without engaging people’s hearts does not change perceptions around FAS. 25,000 South African children are born with FAS each year – and these figures are conservative.
There is a need for more awareness raising initiatives, not only in urban but also in rural communities. In health clinics, in areas where literacy levels are poor, we need to grab people’s attention with ‘in your face’, graphic images of what happens to a foetus when exposed to alcohol. Teachers, social workers and health care workers all need to be trained so that they can educate adults but also adolescent girls and boys about FAS.
We need to dispel the myth that small amounts of alcohol on the unborn baby have little effect. It is imperative that society understands that children do not need to have full FAS to have significant difficulties due to prenatal exposure to alcohol. According to medical experts, even light drinking (average of one-quarter ounce of absolute alcohol daily) can have adverse affects on a child's development, particularly on its verbal language and comprehension skills.
Research on the neurology of prenatal exposure to alcohol also shows that children born to mothers who drank while pregnant, but who did not have a diagnosis of FAS, had many of the same neurological abnormalities as children who had been diagnosed with full FAS.
Damage to the brain from alcohol exposure does have an adverse affect on behaviour. Depending which trimester the pregnancy is in, alcohol exposure damages parts of the brain, while leaving other parts unaffected. Some children exposed to alcohol will have neurological problems in just a few brain areas, whereas others children can have problems in several brain areas. Psychological factors such as abuse and neglect and malnutrition, so prevalent within our poorer rural and urban communities, can exacerbate behaviour problems in FAS.
For teachers and community members, the behaviour of a FAS child is often misinterpreted as wilful misconduct. This will be more apparent in stressful or stimulating situations. In our search for causality, we often attribute behaviour problems in children with FAS to poor parenting skills. While good parenting skills are required, even alcohol-exposed children raised in stable, healthy homes can exhibit aberrant behaviour.
The most difficult behaviours are seen in children who were pre-natally exposed to alcohol and who also suffer from Reactive Attachment Disorder (RAD), a mental health disorder in which a child is unable to form healthy social relationships, particularly with primary caregivers. Often children with RAD will seem charming and helpless to outsiders, while they wage a campaign of terror within the family. RAD is frequently seen in children with FAS who have had inconsistent or abusive care in early childhood, including children adopted from orphanages or foster care.
Most children with FAS have attachment issues, display inappropriate sexual behaviours, show poor judgment, have difficulty controlling their impulses, are emotionally immature, and need frequent reminders of rules. As a result, many will require the protection of close supervision for the rest of their lives.
This reinforces the point I made earlier on: the costs of controlling and supervising a FAS child or teenager is something no community can afford. It is therefore crucial for government and civil society to invest more time and money in raising awareness of FAS and focus its prevention.
(END/2009)
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