Fetal Alcohol Spectrum Disorder: Ethical, Legal and Moral Implications Associated with the Rights of the Unborn Child

Lived experiences of the diagnostic assessment process for fetal alcohol spectrum disorder: A systematic review of qualitative evidence

“…In three studies (Chamberlain et al, 2017 ; Salmon, 2008 ; Sanders & Buck, 2010 ), the assessment journey typically commenced when caregivers recognized behavioral challenges that prompted them to seek help ( GRADE CERQual confidence level: Moderate ). These challenges included oppositional defiance, aggressive behavior, and severe impulsivity, that for some children, was out of character.…”

“…In three studies (Chamberlain et al, 2017 ; Salmon, 2008 ; Sanders & Buck, 2010 ), caregivers reported accessing numerous services for their child's behavioral concerns but perceived these to be unhelpful and in some cases negative, including not feeling listened to and having their concerns dismissed by health professionals (GRADE CERQual confidence level: High ). In one study (Salmon, 2008 ), caregivers reported being viewed as a “neurotic” or “hypochondriac” by health professionals and one caregiver said their adolescent's behavior was labeled as “attention‐seeking” (ps. e201‐2).…”

“…e201‐2). Salmon ( 2008 ) also reported that many biological mothers felt unsupported and “left to it, without sufficient information or explanation” for their child's behavioral challenges (p. e201). In one study (Chamberlain et al, 2017 ), caregivers reported feeling judged about their parenting style and said their child's difficulties were often attributed to family or environmental factors.…”

“…In seven studies (Doak et al, 2019 ; Duquette & Stodel, 2005 ; Petrenko et al, 2014 ; Salmon, 2008 ; Sanders & Buck, 2010 ; Thomas & Mukherjee, 2019 ; Watson et al, 2013 ), caregivers reported that FASD was not considered as a possible diagnostic outcome, even when caregivers raised the topic of PAE/FASD with health professionals ( GRADE CERQual confidence level: High ). In two studies (Salmon, 2008 ; Thomas & Mukherjee, 2019 ), biological mothers who disclosed alcohol consumption during pregnancy in the context of seeking a diagnosis, reported that health professionals refused to acknowledge FASD and described the label as associated with guilt and stigma for families. Caregivers also reported misconceptions among health professionals about timing of PAE and FASD, with one biological mother told that FASD “was not possible” due to drinking “too late in the game” (Watson et al, 2013 , p. 108).…”

“…There was frustration among caregivers at the lack of FASD knowledge among health professionals when they attempted to seek a diagnosis, with reports that nobody “seemed to be cognizant of fetal alcohol” (Sanders & Buck, 2010 , p. 312) or “had ever heard of FASD” (Salmon, 2008 , p. e200). Some caregivers reported that when children did not have any discernible facial features, it was difficult to obtain a FASD diagnosis (Petrenko et al, 2014 ; Watson et al, 2013 ).…”