Pregnancy, alcohol and ADHD
Diagnosing foetal alcohol spectrum disorder in children can be fraught with issues.
It's not the doctor's fault, really. Attention deficit hyperactivity disorder (ADHD) has become an acceptable label to paste on children these days. Everyone knows about the prevalence of ADHD; it seems to explain so much about the behaviour of young boys, in particular. Most particularly, it locates the source of the problem in the child. Parents, and society, are absolved of any responsibility.
But what if the problem is something else? What if, as a doctor, you're aware that the young mother may have indulged in binge drinking - not often, you understand, just a bit - during her pregnancy? What if the mother (who loves and adores her child absolutely, that's not in any doubt) got a bit tipsy every now and then? Do you then reach for the label of foetal alcohol spectrum disorder (FASD) for her child?
Because if you do, things change. For a start, the doctor is now blaming the mother for the child's mental condition. It implies - no, asserts - that she drank during pregnancy, when the National Health and Medical Research Council now strenuously recommends a mother shouldn't. But the other effect is that you rip away the few props of government support that are available.
As well as that, you probably can't be completely certain of your diagnosis. There's not a lot of information about FASD, whereas everyone's heard about ADHD.
And the ramifications are enormous of doctors labelling these children as having FASD, instead of ADHD, is enormous. For a start, the current situation really suits the alcohol industry, and that's a big consideration if you're a politician. The tobacco industry is big, but gambling and alcohol … well, that's where the real money is. You take on Goliaths such as that at your peril.
When the NHMRC changed its warning to urge expectant mothers to avoid alcohol completely, Sydney's Daily Telegraph ran a story criticising the doctors' advice. Unsurprisingly, perhaps, significant sections of the industry appear unwilling to accept even this simple warning. Yet all it was attempting to do was educate mothers that if they drank when pregnant, their children risked significant brain damage. Evidence suggests this is concentrated in the frontal lobes of the brain. This can result in cognitive deficits and inability to concentrate and co-operate with others - symptoms similar to those of ADHD.
The chairman of a parliamentary committee that investigated FASD, Graham Perrett, holds the seat of Moreton, the most marginal Labor seat in Queensland. He has two chances of being returned after the next election: Buckley's and none. Perhaps that's why he's prepared to do something about this issue.
"I have a seven- and a four-year-old and the advice we received as a couple was that the odd drink didn't hurt," he says.
But now, he says, the best medical advice has changed. "Medical thinking has evolved - it's not just don't get drunk, it's don't drink."
Perrett isn't the only MP who is seriously concerned about this issue. Dr Sharman Stone, the member for the rural Victorian seat of Murray, sees the cost of binge drinking and the terrible human toll, particularly among the indigenous communities in her electorate. She has been a driving force, alerting her colleagues to the human and financial costs of the problem.
The committee that investigated the problem wasn't, as you might expect, looking into the medical or economic ramifications of this issue. Instead, the Standing Committee on Social Policy and Legal Affairs was left to make the 19 crystal-clear recommendations that stand at the end of the brief but horrific report. The report was tabled last year. The government hasn't indicated when, or how, it will act to implement any of these suggestions, despite the obvious need for urgent action.
Of course, the difficulty is that doing something would require taking on the status quo. That's something no government wants to do in an election year, particularly when it means making an enemy of an industry that has deep pockets. And what's a bit of brain damage, here and there …
Nicholas Stuart is a Canberra writer.