In recent years concern about Foetal Alcohol Spectrum Disorder (FASD) has intensified, prompting calls for societal action. Pregnant women's consumption of alcohol is increasingly surveilled, public health campaigns now promote abstinence, and in some jurisdictions, prenatal alcohol exposure (PAE) resulting in FASD has received criminal sanction. This paper anticipates potential calls to criminalise PAE resulting in FASD by envisioning what such a case might look like. Applying Duff et al's framework for determining whether an act should be criminalised, we draw upon public health and jurisprudential discourses to trace the outline of an argument for framing maternal alcohol consumption causing injury to the child born alive as a public wrong and a crime.1 We show how an ‘in principle’ case may be constructed, but argue that countervailing principles, including women's rights, and practical considerations, tell decisively against criminalisation.

Alcohol abuse among women is a public health importance that may impair prenatal and postnatal growth. Tella is among the most common homemade alcoholic beverages in rural Ethiopia, but little is known about the magnitude of tella intake during pregnancy and lactation or its effects on child growth. The present study investigated associations between maternal tella intake and the growth of their children. A cross-sectional mixed-methods study was conducted with mothers (n 228) and their 12–36-month-old children and with key informants (n 12). Tella intake during most recent pregnancy and lactation was estimated retrospectively by glasses per drinking event and frequency of events. Nearly 80 % of mothers had consumed some amount of tella during their most recent pregnancy and lactation. Furthermore, 72 % of children had tasted or drunk tella at some time during their life. Stunting was 42 % and was significantly associated with maternal tella consumption at least every other day during pregnancy (adjusted odds ratio (AOR) 4⋅97, 95 % confidence interval (CI) 2⋅20, 11⋅25), male sex (AOR 2⋅31, 95 % CI 1⋅27, 4⋅19), two or more under-5-year-old children in the household (AOR 3⋅52, 95 % CI 1⋅49, 8⋅33) and family size >5 (AOR 1⋅84, 95 % CI 1⋅01, 3⋅36). Underweight was 24⋅6 % and was associated with the child drinking tella with their mother (AOR 4⋅23, 95 % CI 1⋅99, 8⋅97), being male (AOR 3⋅73, 95 % CI 1⋅73, 7⋅94), having ≥3 diarrhoeal episodes in the last 3 months (AOR 11⋅83, 95 % CI 4⋅22, 33⋅14) and being in the older age group (AOR 2⋅98, 95 % CI 1⋅09, 8⋅13). The associations between tella intake and child growth suggest the need to mitigate the effects of tella on child anthropometry.

While fetal alcohol spectrum disorder (FASD) has primarily been thought of as a neurodevelopmental condition, research is beginning to highlight its ‘whole-body’ implications. Accordingly, the current study sought to provide a snapshot of potential health issues. Caregivers of children (median age of 12 years) with an FASD diagnosis were invited to participate in an online survey. Information relating to sample demographics, FASD status of the child and health outcomes were collected. The prevalence of health conditions reported in the FASD sample was compared against national prevalence data. Multiple linear regression utilising a stepwise approach was used to investigate potential predictors of the number of diagnosed health conditions. Survey data were from an international cohort (n = 197), with the majority of respondents based in Australia (40.2%) or the United States (27.7%). The most commonly reported diagnosed health conditions were eye conditions (44.7%), asthma (34.5%), heart conditions (34.0%) and skin conditions (27.4%). Binomial testing indicated the proportion of children diagnosed with these disorders was generally higher in the current FASD population, compared to national prevalence data. Indicators of metabolic dysfunction including diabetes and obesity were not significantly different compared to national prevalence data. Age of FASD diagnosis, existence of comorbid mental health conditions and the primary caregiver being in paid work were identified as being associated with the prevalence of diagnosed health conditions. Overall, the study has provided an up-to-date snapshot of health problems reported in a sample of children with FASD, confirming their increased risk of adverse health outcomes.

Objectives: Caregivers of youth with heavy prenatal alcohol exposure report impaired communication, which can significantly impact quality of life. Using data collected as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders (CIFASD), we examined whether cognitive variables predict communication ability of youth with histories of heavy prenatal alcohol exposure. Methods: Subjects (ages 10–16 years) comprised two groups: adolescents with heavy prenatal alcohol exposure (AE) and non-exposed controls (CON). Selected measures of executive function (NEPSY, Delis-Kaplan Executive Function System), working memory (CANTAB), and language were tested in the child, while parents completed communication ratings (Vineland Adaptive Behavior Scales – Second Edition). Separate multiple regression analyses determined which cognitive domains predicted communication ability. A final, global model of communication comprised the three cognitive models. Results: Spatial Working Memory and Inhibition significantly contributed to communication ability across groups. Twenty Questions performance related to communication ability in the CON group only while Word Generation performance related to communication ability in the AE group only. Effects remained significant in the global model, with the exception of Spatial Working Memory. Conclusions: Both groups displayed a relation between communication and Spatial Working Memory and Inhibition. Stronger communication ability related to stronger verbal fluency in the AE group and Twenty Questions performance in the CON group. These findings suggest that alcohol-exposed adolescents may rely more heavily on learned verbal storage or fluency for daily communication while non-exposed adolescents may rely more heavily on abstract thinking and verbal efficiency. Interventions aimed at aspects of executive function may be most effective at improving communication ability of these individuals. (JINS, 2018, 24, 1026–1037)

Individuals with fetal alcohol spectrum disorders (FASD) have difficulties with cognitive-based executive function (EF) tasks. The goal of the present study was to determine if children with FASD have impairments on the Iowa Gambling Task (IGT), which measures affective EF (i.e., decision-making and risk-taking). Individuals with FASD (n = 31) and healthy controls (n = 31), aged 8–17 completed the IGT. Children with FASD were significantly impaired on the IGT compared to controls. Over the course of the task, control scores improved, whereas children with FASD exhibited an overall decrease in scores. Scores increased significantly with age in the control group but did not differ significantly with age for FASD participants. Children with FASD exhibited decision-making and risk-taking impairments on a hot EF task. Children with FASD did not appear to learn from negative experiences and shift to making more positive decisions over time and their performance did not improve with age. The implications of poor task performance and a lack of age-related findings in children with FASD are discussed. (JINS, 2012, 18, 1–8)

The corpus callosum (CC) is one of several brain structures affected in children prenatally exposed to alcohol. This structure plays a major role in coordinating motor activity from opposite sides of the body, and deficits in bimanual coordination have been documented in individuals with agenesis of or damage to the CC, particularly when the task is performed without visual feedback. The Bimanual Coordination Test was used to assess speed and accuracy on a task where both hands must coordinate to guide a cursor through angled pathways providing measures of interhemispheric interaction or the ability of the two hemispheres to coordinate activity via the corpus callosum. Twenty-one children with fetal alcohol spectrum disorders (FASD) and 17 non-exposed control children (CON), matched closely in age, sex, and ethnicity were tested. For trials with visual feedback (WV), children with FASD were slower than CON children but were equally accurate. Although statistically significant group differences were not observed on most trials completed without visual feedback (WOV), accuracy of the FASD group on WOV trials was highly variable. Group differences in accuracy on WOV angles approached significance after accounting for performance on the WV angles, and children with FASD were significantly less accurate on an individual angle believed to be particularly sensitive to interhemispheric interaction. These results indicate that children with FASD are slower than CON children but equally accurate on basic visuomotor tasks. However, as task complexity and reliance on interhemispheric interaction increases, children with FASD demonstrate variable and inaccurate performance. Preliminary analyses suggest that inaccurate performance on the bimanual coordination task, and presumably impaired callosal functioning, may be related to the attention and problem solving impairments commonly reported in children with FASD. (JINS, 2004, 10, 536–548.)

Prenatal alcohol exposure is associated with widespread and devastating neurodevelopmental deficits. Numerous reports have suggested memory deficits in both humans and animals exposed prenatally to alcohol. However, the nature of these memory deficits remains to be characterized. Recently children with fetal alcohol syndrome were shown to have learning and memory deficits on a verbal learning and memory measure that involved free recall and recognition memory. The current study seeks to further characterize memory functioning in children with heavy prenatal alcohol exposure by evaluating priming performance. The choice of task is also relevant given previous studies of memory performance in patient groups with and without involvement of the basal ganglia, a group of structures known to be affected in fetal alcohol syndrome. Three groups were evaluated for lexical priming, free recall, recognition memory, and verbal fluency: (1) children with heavy prenatal alcohol exposure; (2) children with Down syndrome; and (3) nonexposed controls. The children with Down syndrome showed significantly less priming than alcohol-exposed children, who did not differ from controls. In addition, the alcohol-exposed children were impaired on the free recall task but not on the recognition memory task, whereas the children with Down syndrome performed significantly worse than the alcohol-exposed group on both tasks. Finally, on the verbal fluency task, children with heavy prenatal alcohol exposure were impaired on both category and letter fluency, but the degree of impairment was greater for letter fluency. These results further characterize the memory deficits in children with heavy prenatal alcohol exposure suggesting that in spite of learning and memory deficits, they are able to benefit from priming of verbal information. (JINS, 1999, 5, 462–471.)