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Parents are normally concerned about their children’s development, well-being, and future. Would-be parents are equally concerned. What if there was an epidemic of brain damage affecting thousands of children in the UK, more commonly than many conditions we regularly hear about, yet it remains largely unseen and undiagnosed? In the previous article we learned about FASD.

This is the silent crisis of Foetal Alcohol Related Damage (FARD) – a term that encompasses the entire spectrum of harms – including FASD– caused when an unborn baby is exposed to alcohol. It’s a preventable form of lifelong brain damage, one that affects children across our communities, yet often goes undetected, leaving families to navigate a complex labyrinth of challenges. FARD therefore includes all of FAS, pFAS and ARND (alcohol related neurodevelopmental damage) [McQuire et al 2018]. FARD moves the issue from diagnosis into a the realm of public health.

NHS data reveals that approximately 41% of women have drunk alcohol at some point in pregnancy – either before or after they knew they had conceived. [Women and alcohol – Institute of Alcohol Studies, 2021]

Comparison of Alcohol-Related Neurodevelopmental Terminology

Term	Type	Definition / Scope	Clinical Diagnosis?	Key Features
Foetal Alcohol Syndrome (FAS)	Diagnostic subtype	The most severe, recognisable form of prenatal alcohol harm with defined facial features, growth restriction, and CNS dysfunction.	✅Yes	Facial dysmorphia, growth deficits, brain abnormalities.
Partial FAS (pFAS)	Diagnostic subtype	Presents with some but not all facial features of FAS, with confirmed CNS dysfunction and prenatal alcohol exposure.	✅Yes	Cognitive/behavioural issues with partial facial signs.
Alcohol-Related Neurodevelopmental Disorder (ARND)	Diagnostic subtype	CNS or behavioural impairments without characteristic facial features, but confirmed alcohol exposure.	✅Yes (in some systems)	Executive dysfunction, memory, learning disorders — often goes unrecognised.
Foetal Alcohol Spectrum Disorder (FASD)	Diagnostic umbrella	An umbrella term encompassing FAS, pFAS, ARND, and other neurodevelopmental conditions due to alcohol exposure.	✅Yes (UK, Canada, etc.)	Diagnostic category with defined criteria; acknowledges spectrum of impairments.
Foetal Alcohol Related Damage (FARD)	Public health concept	A broad, non-diagnostic term encompassing all neurodevelopmental, behavioural, and societal harm resulting from prenatal alcohol exposure — including undiagnosed cases.	❌No	Policy-focused term recognising that most harm is unseen, unrecorded, and systemically overlooked.

What is FARD? More Than Just a Single Condition

FARD isn’t a single illness; it’s a spectrum of permanent disabilities. At its most severe, it includes Foetal Alcohol Syndrome (FAS), which can involve distinctive facial features and growth problems. But far more commonly, FARD manifests as invisible brain damage, leading to:

• Learning difficulties: Problems with memory, attention, and academic progress.
• Behavioural challenges: Issues with impulse control, emotional regulation, hyperactivity, and social understanding.
• Developmental delays: Slower progress in walking, talking, and acquiring life skills.

These are lifelong struggles, profoundly impacting a child’s ability to learn, thrive, and integrate into society.

Why FARD Matters

• FARD reframes the issue as a population-level epidemic rather than a narrow clinical subset.
• Captures underdiagnosed or mislabelled cases that never receive a formal FASD diagnosis but still experience lifelong impairment.
• Aids communication with policymakers by drawing attention to unseen costs across education, health, and justice.
• Offers a platform for preventive strategies, including legislative and biomarker-informed approaches.

Category	Psychological/Neurodevelopmental Features	Physical Features (from mild to severe)
Common/Core	• Memory deficits (especially working memory) • Attention problems • Executive function difficulties (planning, judgment, impulse control) • Emotional dysregulation • Hyperactivity • Social skill deficits • Learning disabilities • Speech and language delays • Lower IQ / Intellectual disability (varying severity)	• Growth deficits (shorter height, lower weight, smaller head circumference) • Poor coordination / balance
Specific/Severe	• Significant challenges with abstract thinking • Difficulty understanding cause and effect • Challenges with daily living skills • Increased risk of mental health conditions (e.g., anxiety, depression, substance use disorders) • Higher likelihood of criminal justice system involvement	• Characteristic facial features (for FAS: small eye openings, smooth philtrum, thin upper lip) • Heart defects (e.g., septal defects) • Kidney and urinary tract problems • Bone and joint abnormalities • Vision or hearing impairment • Other structural anomalies (e.g., limb defects)

The Startling Scale: More Common Than You Think

Recent, ground-breaking research from Greater Manchester has shone a light on the true prevalence of FARD in the UK. This “gold-standard” study, actively looking for the condition in primary school children, found that a staggering 3.6% of children screened showed signs of Foetal Alcohol Related Damage. This figure includes both children with a definitive diagnosis of Foetal Alcohol Spectrum Disorder (FASD) and an equal number with “possible FASD”—meaning they have significant neurodevelopmental challenges where prenatal alcohol exposure is a likely contributing factor.

To put that 3.6% into perspective, consider this:

• Schizophrenia, a severe mental illness, affects around 0.5-0.7% of the general population at any given time.
• Bipolar Disorder typically impacts 1-2%.
• Even Autism Spectrum Disorder (ASD), which has seen immense growth in awareness and support, is estimated to affect around 1-2% of children.
• The 3.6% for FARD puts it in a similar prevalence range to ADHD, one of the most common neurodevelopmental disorders in childhood (3-5%).

This means that FARD is as common as, or even more common than, many conditions we openly discuss, fund, and for which we have established diagnostic and support pathways.

Why is This Epidemic Hidden? The Underdiagnosis Crisis

The most heartbreaking finding from the Greater Manchester study was that not a single child definitively diagnosed with FASD had received a prior diagnosis from a clinical service. This astonishing fact reveals the core of the problem: FARD is an unseen crisis.

It’s hidden for several reasons:

• Invisible scars: Most children with don’t have obvious physical signs; their challenges are primarily neurological and behavioural.
• Mimicking other conditions: The symptoms of FARD often overlap with, and are therefore misdiagnosed as, ADHD, autism, anxiety, or general learning difficulties.
• Lack of awareness and training: Many healthcare professionals and educators lack specific training in recognising the full spectrum of FARD.
• Stigma: Parents may feel unable to disclose past alcohol use during pregnancy due to fear of judgment, preventing the crucial link to diagnosis from being made.

The consequence of this underdiagnosis is devastating. Children with FARD are often not receiving the tailored support they desperately need, leading to years of frustration for them and their families, difficulties in school, and a higher risk of struggling with mental health issues or even encountering the criminal justice system later in life.

The Preventable Truth: A Call to Action

The most poignant fact about FARD is its preventability. There is no known safe amount of alcohol during pregnancy; the Chief Medical Officer advises complete abstinence if you are pregnant or planning to be.

Good parents want the best for their children. Understanding the profound and lifelong impact of FARD is the first step. We need:

• Increased public awareness: Clear, consistent messaging about the dangers of alcohol in pregnancy, without judgment.
• Better professional training: Equipping doctors, nurses, teachers, and social workers to recognise, diagnose, and support children with FARD.
• Accessible diagnostic pathways: Ensuring families can get a timely and accurate diagnosis to unlock appropriate support.
• Compassionate support: Offering non-judgmental help and resources for pregnant individuals struggling with alcohol use, focusing on support rather than punishment.

By making this hidden epidemic visible, we can empower future generations, ensuring every child has the best possible start in life, free from the preventable shadow of Foetal Alcohol Related Damage. It’s a conversation we can no longer afford to ignore.

The Regulatory Paradox: Why Alcohol is Different from Valproate

The reality of FARD highlights a profound paradox in how our society regulates substances known to harm unborn children. If a heavily addictive compound like alcohol were a prescribed medication, the response to its discovery as a foetal neurotoxin would be swift and absolute. Imagine the outrage, the immediate recalls, the severe restrictions, and the public campaigns demanding accountability. There would be no question about “should it remain legal for sale.”

Consider the real-world example of valproate, a prescribed medication. When its significant teratogenic risks, including a high chance of severe birth defects (around 11%, such as spina bifida) and neurodevelopmental disorders (30-40% risk), became fully evident, strict legal and medical regulations were implemented. These include mandatory Pregnancy Prevention Programmes, signed risk acknowledgement forms, and specialist-only prescribing, all aimed at minimising foetal exposure and holding prescribers accountable. Society accepts these stringent controls because it’s a medication, dispensed under medical authority, implying a duty of care.

However, alcohol, despite its established ability to cause widespread and often severe “Foetal Alcohol Related Damage” (FARD), operates under an entirely different framework. It is a legally sold consumer product, deeply woven into our social fabric. This distinction means there’s no “prescriber” to conduct a risk-benefit analysis for every pregnant individual. The regulatory approach relies primarily on public health messaging and guidance, not the strict legal prohibitions or accountability mechanisms applied to prescribed drugs. This ethical dilemma—balancing individual autonomy against the profound, preventable harm to unborn children from a widely available substance—is at the heart of why the FARD epidemic remains so stubbornly hidden and under-addressed. It compels us to ask if our regulatory distinctions truly serve the best interests of every child.

The Multi-Faceted Impact of FARD

The pervasive reality of FARD creates ripple effects across every layer of society, touching upon complex moral, ethical, legal, and economic dimensions.

Morally, the presence of preventable, lifelong brain damage in children challenges our fundamental sense of justice and compassion. It compels us to confront the uncomfortable truth that a society aware of such harm, yet failing to adequately prevent or address it, is falling short of its deepest moral obligations to its most vulnerable members. This is compounded by the personal guilt and anguish experienced by mothers who unknowingly caused harm, often due to a lack of clear, consistent information.

Ethically, the issue navigates a fraught tension between individual autonomy and collective responsibility. While a pregnant person has the right to make choices about their own body, society also has a compelling ethical duty to protect unborn life from foreseeable, preventable harm. Policies surrounding FARD must delicately balance these principles, seeking to inform and support rather than coerce, yet still striving to ensure the best possible start for every child. This extends to the ethical responsibility of industries that produce and market substances known to be teratogenic.

Legally, FARD presents significant complexities. While UK law has historically resisted criminalising maternal behaviour during pregnancy for foetal harm, the existence of FARD places a substantial burden on existing legal frameworks. Affected individuals often require extensive support under disability, education, and social care legislation. Furthermore, the disproportionate involvement of individuals with FARD in the criminal justice system, due to their neurodevelopmental challenges, raises profound questions about fair process, appropriate sentencing, and the need for specialised legal and correctional responses. The lack of formal FARD diagnosis also means individuals may not access their full legal rights to support and accommodations.

Finally, the economic impact of FARD is largely underestimated. For the UK it runs into the billions annually, rivalling those of many well-recognised mental health conditions. These costs span various sectors: the National Health Service for medical complications and ongoing care; local authorities for extensive social care and support services; education systems for specialised learning provisions; and the criminal justice system for disproportionate involvement, incarceration, and recidivism. These economic burdens are sustained over an individual’s lifetime, representing a vast, preventable drain on public resources that could otherwise be invested in other areas of societal well-being. Addressing FARD effectively is a moral imperative, and a significant economic opportunity.

Conclusion

Foetal Alcohol Related Damage is a profound, preventable tragedy, playing out silently in communities across the UK. FARD is a widespread issue, affecting a significant proportion of our children, often more so than many commonly recognised conditions. Due to its invisible nature and the societal paradox in how we regulate substances like alcohol versus prescribed medications like valproate, FARD remains largely undiagnosed and misunderstood.

This hidden epidemic not only deprives affected children of the tailored support they desperately need but also places immense, unacknowledged burdens on families and public services. It is a stark reminder that while individual choices are paramount, society also bears a collective responsibility to protect its most vulnerable members from preventable harm. By fostering greater awareness, improving professional training, establishing clear diagnostic pathways, and providing compassionate support, we can begin to lift the veil on this hidden crisis and ensure a healthier, more equitable future for all children.

The sheer scale of this preventable harm to children, coupled with the vast economic burden it places on public services, presents a compelling rationale for a stronger legislative framework. While outright prohibition might infringe on individual liberties, targeted legislation could mandate clearer, more prominent warning labels on all alcohol products about pregnancy risks. It could also support comprehensive, universal screening for alcohol use in pregnancy within healthcare, linked to non-punitive support services rather than punitive action. Such measures, grounded in public health principles and the ethical duty to protect children, would aim to ensure that all pregnant individuals receive consistent, explicit information and compassionate help, making informed choices truly possible and moving beyond a reliance solely on individual awareness in the face of a hidden national crisis.