Patterns Of Child Abuse in Children With Fetal Alcohol Spectrum Disorder (Fasd)

Abstract

Background: Children with an FASD diagnosis may be at an increased risk of abuse due to the coexistence of many of the risk factors for child abuse. Further, it has been reported that being a victim of physical, sexual abuse/domestic violence increases the risk of these individuals to have poor outcomes. Studies have looked at the risk of child abuse by mothers who abused drugs, such as cocaine, in pregnancy. It is equally important to characterize the risk of child abuse in alcohol-exposed children. Although there are various reports of increased abuse in alcohol-exposed children, it appears that the patterns of this abuse have not been characterized previously. Objective: To describe patterns of abuse identified on referral in children who have an FASD and who have been referred to Winnipeg's Child Protection Center (CPC). Methods: This study was a retrospective chart review. Children seen at The Clinic for Alcohol and Drug Exposed Children (CADEC) between 2003 and 2007 who received a diagnosis of Fetal Alcohol Syndrome (FAS), partial Fetal Alcohol Syndrome (pFAS), Alcohol Related Neurodevelopmental Disorder (ARND) or labelled At Risk (ie. children who have been exposed but not yet diagnosed) were selected. These were crossmatched to the database of referrals at CPC. Data was collected on children who were seen at both CPC and CADEC. Results: Seventeen percent of children seen at CADEC had a referral initiated to CPC. Abuse was substantiated in thirty three percent. Children with ARND and At Risk were more commonly referred to CPC. Referrals initiated for physical and sexual abuse were seen to occur together more frequently, with females having more referrals for suspected sexual abuse and males for suspected physical abuse and developmental assessment. Further, eleven children had at least one referral for a parent-child assessment, twenty for a developmental assessment, and ten were in a CPC file because of a family member's involvement with CPC. Conclusions: Children whose lack of dysmorphology may not immediately identify them as having an FASD were more commonly suspected of suffering child abuse. The differences in gender and referrals could be a function of externalizing behaviour in males, and greater vulnerability in females for sexual abuse. The number of children cross represented in both systems underscore the importance of early diagnosis and appropriate support systems in homes caring for these children at risk.