CAPSS webinar #5 - Fetal Alcohol Spectrum Disorders (FASD): Overview of what a psychiatrist needs to know

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FASD is an increasingly recognised condition which represents the most common single aetiological cause of neurodevelopmental presentations, which is also preventable. With rates of between 2-4% of the UK population suggested to have FASD, in some groups such as those in care, the rates have been suggested to be as high as 27%.

Whilst many recognise the full dysmorphic profile of FASD, this is relatively uncommon with often less than 5 % of those diagnosed meeting full criteria on the facial criteria. Updated diagnostic profiling from the Scottish SIGN guidance, adopted in England, and NICE Quality Standards published in March 22, are driving the need for better recognition and change. FASD is therefore now a condition that in increasingly presenting and demand for recognition by families is growing, yet many professionals still find themselves with only limited knowledge about FASD.

FASD presents with a complex neurodevelopmental profile and overlays complex trauma issues that lead to behavioural challenges to many areas including CAMHS, ID, Forensic and General Adult psychiatric services. The lack of recognition often leads to impropriate service utilisation, therefore better recognition and understanding will help to appropriately deliver treatment and support to this vulnerable group. There are increasingly specific treatment pathways developing for this group that increases the importance of recognition and support.

• What FASD is and the different risk of alcohol prenatally at different levels to an individual
• Prevalence in the UK and in some other at-risk populations
• FASD in the context of a complex trauma model
• Where FASD fits into a wider Neurodevelopmental world
• Developing treatment and intervention approaches specific to FASD

Professor Raja Mukherjee is an Adult Learning Disability Consultant Psychiatrist for Surrey and Border’s Partnership NHS Foundation Trust, with interest in the management of developmental disorders across the lifespan. In September 2009 he started the first NHS based specialist Fetal Alcohol Spectrum Disorders behavioural clinic and since then has seen over 250 cases for specialist second opinion as a National referral service. Dr Mukherjee completed his PhD on the subject of Fetal Alcohol Syndrome in 2014.

He has also acted as an invited advisor to the BMA board of science, The Department of Health and the World Health Organisation on the subject of FASD. In 2015 Dr Mukherjee also gave evidence to the first All Party Parliamentary Group on FASD at the House of commons. He has continues to support national clinical developments related to FASD. Dr Mukherjee is a member of the NICE quality standards group for FASD. He is currently the only UK representative to a US, NIH sponsored initiative to consider the research criteria for FASD. In his own time he volunteers as a medical advisor to various FASD charities both in the UK and internationally. In 2021 he was made an Honorary Professor at the University of Salford related to his work on FASD.

In wider work, he is currently Clinical Lead for Adult neurodevelopmental services provided by Surrey and Borders including Adult ASD and ADHD services across Surrey, Hampshire and Portsmouth. He is a an executive committee member of the RCPsych SIG on neurodevelopmental disorders, and Finance officer from July 2021. He is also a member of the ID Faculty Executive.