Newsletter 174 - Learners with Fetal Alcohol Syndrome (FAS)

“Developmental disabilities and behavioral problems among school children in the Western Cape of South Africa” by Ellen Giarelli, Darren L. Clarke, Christopher Catching , Sarah J. Ratcliffe

Fetal alcohol syndrome and DD and BP

Developmental disabilities (DD) and behavior problems (BP)

It is well known that alcohol use and alcoholism are ongoing problems in wine producing communities in SA (Centers for Disease Control and Prevention, 2003; Mager, 2004). Almost 50% of pregnant mothers in the Western Cape Province (WCP) drink alcohol and come from families with a history of generations of alcohol abuse (South African National Department of Health, 2001). Various measures of maternal drinking are significantly correlated with negative outcomes in children (Mager, 2004). FAS causes DD and BP including fine and gross motor problems, hyperactivity, intellectual disabilities, verbal and learning problems, language disorders, emotional difficulties, and impairment of information processing (Adnans et al., 2001; Rosenthal, Christianson, & Cordera, 2005). In fact, DD and BP are indicators of FAS. The WCP is a high prevalence area for FAS with rates of 40.5–46.4 per 1000 (May et al., 2000) and 65.2–74.2 per 1000 (Viljoen et al., 2005) compared to 0.97 per 1000 in the developed world. In 2007, rates of FAS were confirmed and documented in the community targeted by our study (May et al., 2007).


Developmental disabilities

For the entire sample of children, 42% screened positive for 1 or more possible DD. Twenty-one percent had two or more DDs.  DDs are; appearance of mentally backward or dull 29.3%, cannot make self-understood in words, none recognizable 13.8%, does not seem to understand what you are saying 12.6%, speech is different than normal 8.6%), and difficulty hearing14, 8%). The highest prevalence was 29.3%.

These items may correspond with communication disorders or be a manifestation of a problem with cognition. There was no significant difference in the number of DDs by sex. There was a significant difference in the number of DDs by grade such that grade 1 had more reported DDs than grade R.


Behavioral problems

The five most frequently recorded problem behaviors that were observed ‘‘sometimes’’ or ‘‘all the time’’ were kicks and/or hits others 49%, laughs or giggles for no obvious reason 49%, becomes overexcited 45%), wanders aimlessly 43%, and preoccupied with only one or two particular interests 40%.

The teachers reported more behavioral problems among children in grade R. This is intuitively reasonable because the young child may experience higher anxiety upon entry into formal schooling; being grouped with a large number of peers; and having increased expectations placed upon him or her to perform and adapt to the rules of the classroom. The presence of DDs and/or BPs has implications for health, rehabilitation, welfare, and educational services, but especially in rural areas where services may be curtailed or non-existent and children may have been orphaned or have lost a parent to AIDS (Giarelli & Jacobs, 2001). The World Health

Organization (WHO, 1997) estimated that one in 10 children in developing countries has special needs in education. Our study illustrates the possibility the figure may be higher.

There are pragmatic reasons to increase attention to these children, including a systematic screening of children upon entry into formal schooling. The school may be the only source of attention and health care. Unmanaged behavioral problems disrupt the classroom experiences for all learners. Deficiencies may become more prominent as performance demands increase with age and grade, and early formal identification of those who screen positive may mitigate future learning and functional problems. A child who is slow to develop and who needs extra emotional and educational attention and care is more difficult to support in a poor and disadvantaged community (Dawson, Hollins, Mukongolwa, & Witchalls, 2003).

The worthy aim of providing services for children with DD and BP requires provision and organization of appropriate and adequate support services schools, families, and communities; along with protective and enabling legislation. It also requires support services for parents, including engaging them in some aspects of school reform.

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