Children adopted from orphanages or in foster care have a high rate of fetal alcohol syndrome and other physical, mental, and behavioral problems related to alcohol exposure before birth, according to a new review of past studies.
Among those children, researchers found that rates of alcohol-related problems - which can include deformities, mental retardation and learning disabilities - were anywhere from nine to 60 times higher than in the general population.
"It's increasingly well recognized that this is a very high-risk population and one that we should really be paying attention to," Phil Fisher, a psychologist who studies foster and adopted children at the University of Oregon in Eugene, said.
"We know that one of the main reasons that kids end up in foster care or being made eligible for adoption is because their parents have substance abuse problems," added Fisher, who wasn't involved in the new research.
The findings are based on a review of 33 studies of children in the care of child welfare agencies or foster parents, as well as kids before and after their adoption from orphanages. Most of the studies were conducted in Russia
or the United States.
Compiling the studies with the most accurate reporting techniques, Dr. Svetlana Popova from the Center for Addiction and Mental Health in Toronto and her colleagues found six percent of children in those settings had fetal alcohol syndrome.
The condition includes a distinctive set of facial features, including a small head, jaw and eyes, and other physical developmental defects, especially of the heart. Slow growth and delayed development after birth are also typical of fetal alcohol syndrome.
Close to 17 percent of the children had a more loosely defined fetal alcohol spectrum disorder, which covers any physical, mental or behavioral issues caused by prenatal alcohol exposure.
The highest rates of fetal alcohol syndrome were seen among children in a Russian orphanage for kids with special needs and among those adopted from Eastern Europe by families in Sweden. In those studies, anywhere from 29 percent to 68 percent of children showed severe alcohol-related damage.
In other cases, such as a study of Chinese children adopted and brought to the United States, there were no reported instances of fetal alcohol syndrome, the study team reported Monday in Pediatrics.
Fisher said it's important to know that although problems related to alcohol exposure are common among adopted and foster children, not all kids have been exposed - and some with prenatal exposure are "quite resilient" and do fine.
"I don't think anyone wants to create the impression that every child in the foster care system … and every child who's adopted has very severe problems," he said.
Still, he said there is a need for more recognition of the challenges faced by children who have been exposed to drugs and alcohol in the womb. Rather than focusing only on their obvious current symptoms, he said fetal alcohol disorders should be treated as chronic diseases, like diabetes.
"The supports need to be available in an ongoing way," Fisher said.
He also pointed to the importance of identifying children who have some of the effects of drug and alcohol exposure - but not ones as obvious as the distinct facial features seen with fetal alcohol syndrome - and getting them support as soon as they enter the child welfare system or are adopted.
"If we don't do the early screening and detection … then I think we're in a much more challenging position," he said.
"We hope that the results of this study will attract attention to the needs of children in care affected by prenatal alcohol exposure," Popova said in an email.
She agreed that spotting problems as soon as possible is important.
"Early screening may lead to early diagnosis, which can lead to early participation in developmental interventions, which can in turn, improve the quality of life for children with a (fetal alcohol spectrum disorder)," she said.
Early intervention, Popova added, may also help prevent future mental health problems and trouble in school.