Intended for healthcare professionals

Rapid response to:


Low level alcohol consumption and the fetus

BMJ 2005; 330 doi: (Published 17 February 2005) Cite this as: BMJ 2005;330:375

Rapid Response:

Awareness of prenatal alcohol intake in the assessment of behavioural problems in children and adolescents

I would like to thank Mukherjee, Hollins, Abou-Saleh and Turk (1) for
reminding us of the significance of alcohol consumption in pregnancy and
highlighting once again, the implications it can have on our clinical
practice. As an SpR in Child and Adolescent Psychiatry in South Wales I
have regular involvement in the initial assessments and follow-up of young
people suffering from attention deficit hyperactivity disorder (ADHD),
autistic spectrum disorder (ASD), and a variety of behavioural problems.

To what extent can the behavioural diagnoses occurring in children
and adolescents be attributed to the fetal alcohol spectrum disorder
described in this editorial? Hyperactivity, impulsivity, and the lack of
awareness of social cues, are all features known to be neurocognitive
effects of prenatal alcohol consumption, (2) in addition to being of
particular interest to the psychiatrist working with children of school

Alcohol is one of many risk factors known to be particularly harmful
at the time of the period of rapid brain growth during fetal development
and early life, resulting in an adverse impact on cognitive development.
Indeed as described in the editorial, evidence shows overlap between
maternal alcohol consumption in pregnancy and the subsequent development
of conditions such as ADHD, and autism. (4)

Everyday we are reminded of the distress and torment that these
disorders can bring to patients and their families. The seemingly
unrelenting affliction will penetrate every area of the child’s life, from
home, through to school and the damaging of education, peer relationships
and self-esteem.
Although I believe that the developmental history is generally an area
which is covered well. I am aware that alcohol intake in pregnancy,
including the stage of gestation and quantity, is not routinely enquired

Recognition of families at risk is of utmost importance, both for the
child in our care and for future children. Any ongoing alcohol use must be
acknowledged, and to what extent this is maintaining the child’s
behaviour. We should consider the effect that alcohol consumption within
the family may be having on compliance with current treatment, including
the attending of appointments, and the safe supervision of any prescribed
stimulant medication.

Until further evidence emerges, I believe widespread awareness is the

(1) Mukherjee RAS, Hollins S, Abou-Saleh MT, Turk J. Low level
alcohol consumption and the fetus. BMJ 2005;330:375-6. (19 February)

(2) Jacobson JL, Jacobson SW. Effects of prenatal alcohol exposure on
child development. Alcohol Res Health 2002;26:282-6.

(3) Streissguth AP, Barr HM, Sampson PD, Bookstein FL. Prenatal
alcohol and offspring development:the first fourteen years. Drug and
Alcohol Dependence 1994;36:89-99

(4) Famy C, Streissguth AP, Unis AS. Mental illness in adults with
fetal alcohol syndrome or fetal alcohol effects. Am J Psychiatry

Competing interests:
None declared

Competing interests: No competing interests

04 March 2005
Anna R Goel
Specialist Registrar in Child and Adolescent Psychiatry
Trehafod Child and Family Clinic, Waunarlwydd Rd, Cockett, Swansea SA2 OGB