Prevalence of fetal alcohol spectrum disorder in Greater Manchester, UK: An active case ascertainment study

Background: Despite high levels of prenatal alcohol exposure in the UK, evidence on the prevalence of fetal alcohol spectrum disorders (FASD) is lacking. This paper reports on FASD prevalence in a small sample of children in primary school. Methods: A two-phase active case ascertainment study was conducted in three mainstream primary schools in Greater Manchester, UK. Schools were located in areas that ranged from relatively deprived to relatively affluent. Initial screening of children aged 8-9 years used pre-specified criteria for elevated FASD risk (small for age; special educational needs; currently/previously in care; significant social/emotional/mental health symptoms). Screen positive children were invited for detailed ascertainment of FASD using gold standard measures including medical history, facial dysmorphology, neurological impairment, executive function and behavioural difficulties. Results: Of 220 eligible children, 50 (23%) screened positive and 12% (26/220) proceeded to phase-two assessment. Twenty had a developmental disorder, of which, four had FASD and four were assessed as possible FASD. The crude prevalence rate of FASD in these schools was 1.8% (95%CI: 1.0%,3.4%) and when including possible cases was 3.6% (2.1%,6.3%). None of these children had previously identified with a developmental diagnosis. Conclusions: FASD was found to be common in these schools, but limitations to the sampling restrict inferences to a population prevalence. Most of these children’s needs had not previously been identified