Behavioral profile of children with prenatal alcohol exposure and kinship and foster carers’ experiences of wellbeing and parenting stress

BACKGROUND: Children’s exposure to alcohol in pregnancy is a known risk factor for the development of life-long cognitive and neurobehavioural difficulties, collectively known as Fetal Alcohol Spectrum Disorders (FASDs). FASDs are more common in care-experienced children, who often have experiences of trauma and neglect. However, children with difficulties associated with prenatal alcohol exposure are frequently misdiagnosed or not identified, limiting their access to effective intervention. These factors have an impact on children’s social, emotional and behavioural outcomes, as well as the experiences of their carers. AIMS: This thesis had three aims: to review the behavioural profile of children with prenatal alcohol exposure (PAE); to investigate the association of care-experienced children’s exposure to alcohol in pregnancy on carers’ wellbeing, parenting stress and efficacy and child behaviour; and to evaluate the differences between kinship and foster carers experiences of wellbeing, parenting stress and efficacy. METHODS: The aims are addressed in two journal articles. The first article presents a systematic review of the research regarding the behavioural profile of children with PAE compared to unexposed children. The second article presents findings from a quantitative cross-sectional study involving kinship and foster carers of children aged 6-18 years old, who completed self-report measures about their wellbeing, parenting stress and efficacy and provided data regarding their care-experienced child’s behaviour and prenatal alcohol exposure. RESULTS: The systematic review demonstrated that children with PAE have greater behavioural difficulties compared to typically developing unexposed controls, as reported by parent- and teacher-report measures. However, differences in behaviour between children with PAE and unexposed children with Attention Deficit Hyperacitivty Disorder (ADHD) was less clear. There were limitations to the research reviewed, particularly regarding the selection of subjects within PAE groups and the operationalisation of behavioural measures associated with neurobehavioural domains. Results from the empirical study highlight the difficulty in capturing PAE in care-experienced children, as many carers were unaware of their children’s PAE status. Significant differences in wellbeing, parenting stress and efficacy were identified between carers of children with and without behaviours associated with PAE. Kinship and foster carers differed on measures of wellbeing and anxiety, but not on parenting stress and efficacy. Significant correlations were found between all carers measures and child behaviour. Due to a lack of robust PAE identification and the limitations to the sample size, these findings require further investigation. CONCLUSIONS: The results of the systematic review highlight the behavioural difficulties demonstrated by children with PAE as identified by parents and teachers. Further investigation of carer-report measures for the purpose of identifying and differentiating a profile of deficits for PAE compared to other neurodevelopmental disorders is needed. The empirical study highlights the association between child behaviour and carer’s wellbeing and experiences of caring. Clinical implications for service providers regarding PAE, care-experienced children and family support are discussed