Use of Health, Education, and Social Services by Individuals with Fetal Alcohol Spectrum Disorder
J Popul Ther Clin Pharmacol Vol 20(2):e95-e106;April 26, 2013
Original Research
Marni D Brownell, Ana C de B. Hanlon Dearman, Leonard R MacWilliam, Albert E Chudley, Noralou P Roos, Lauren P Yallop, Sally E A Longstaffe


Fetal Alcohol Spectrum Disorder (FASD) is the leading cause of intellectual disability in western society, presenting a significant burden on health, education and social services. Quantifying the burden of FASD is important for service planning and policy and program development.

To describe the health, education and social service use of individuals with FASD to provide an indication of the burden of service use of the disorder.

Using a matched-cohort design health, education and social service data were linked with clinical records on individuals 6+ years diagnosed with FASD between 1999/2000-2009/10 (N=717). Matching was 2:1 with a general population (gPop) and asthma group by age, sex and area-level income. Adjusted rates and relative risks were calculated using Generalized Linear Models. 

Hospitalizations were higher in the FASD compared to gPop (adjusted relative risk=3.44 (95% confidence interval=2.29, 5.17)) and asthma (2.87 (1.94, 4.25)) groups, whereas for physician visits and overall prescriptions, the FASD group differed from only the gPop group (1.58 (1.34, 1.84); 1.44 (1.22, 1.72), respectively). Antibiotics, pain killers and anti-psychotics were similar across groups whereas antidepressants and psychostimulants were higher in the FASD group (antidepressants: FASD vs. gPop 8.76 (2.82, 27.21); FASD vs. asthma 2.10 (1.15, 3.83); psychostimulants: FASD vs. gPop 5.78 (2.89, 11.57); FASD vs. asthma 2.47 (1.37, 4.47)). Attention-deficithyperactivity disorder was higher in the FASD than the gPop and asthma groups (6.41 (3.29, 12.49); 3.12 (1.97, 4.93), respectively). Education and social service use was higher for the FASD than either of the other groups for all measures (FASD vs. gPop and FASD vs. asthma, respectively for: grade repetition 3.06 (1.58, 5.94); 3.48 (1.79, 6.78); receipt of any special education funding 9.22 (6.23, 13.64); 6.10 (4.14, 8.99); family receipt of income assistance 1.74 (1.33, 2.27); 1.89 (1.45, 2.47); child in care 13.19 (5.84, 29.78);10.70 (4.80, 23.88); and receipt of child welfare services 5.70 (4.21, 7.71); 4.94 (3.67, 6.66)).

The health, education and social service utilization burden of individuals with FASD is substantial, greater than that of individuals in the general population and with chronic illness (i.e., asthma). The findings highlight the need for multisystem supports for those with FASD, and comprehensive prevention programs. 

Key Words: FASD, health service utilization, social services, administrative data, special education

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