Understanding fetal alcohol syndrome disorder

Around 30 years ago, we became aware that autism was not a simple condition, but rather a spectrum of shades ranging from the palest of greys to the deepest. Alongside this runs a range of learning disabilities running from normal intellect, to the most severe of cognitive impairments. In certain circumstances, these two can be almost independent of one another.
This book discusses a similar spectrum relating to Fetal Alcohol Syndrome (FAS) – and it makes several disturbing assertions along the way. These pose challenges to primary care, educational and social services (and beyond) – and raise significant ethical questions.
As health professionals, we can all recognise the 'classical' physical signs of FAS – the microcephaly, facial dysmorphia, failure to thrive, and developmental delay with which the young child presents, but this book argues that this is, in fact, the minority of cases of Fetal Alcohol Spectrum Disorder (FASD). It then elucidates these more subtle signs of alcohol-induced foetal brain damage. The authors described them clearly and pointed out the ever present danger of misdiagnosis.
The behavioural strategies used for children on the autistic spectrum are not necessarily appropriate for youngsters with FASD nor is the use of stimulants recommended, such as those used in the management of ADHD. Having said this, the behavioural tools suggested in the book, are not earth-shatteringly complex, and should not be beyond any competent professional (the section on sleep management could be a blessing for most parents too).
The long-term risks associated with FASD are significant according to this book, and the presence of this pre-existing insult to the brain can lead to significant consequences – mental ill health (90 per cent), addiction (60 per cent), illegal activity (60 per cent), inability to hold down employment (80 per cent) and failure to live independently (80 per cent).
All of this points towards the ethical elephant in the room. The book's message is clear: FASD is preventable and the only safe level of alcohol intake during pregnancy is none. This is also the primary care message.
In common with ASD, intellectual difficulties may or may not be present in FASD, which makes this a complex spectrum, and hence the need for careful diagnosis and management. A quick exploration of tools available here in the UK revealed that there is a 'kit' for GPs but little else.
In the UK, there is only one centre that specialises in the diagnosis of FASD, and reliable figures for prevalence are not available owing to problems surrounding diagnosis but, a reasonable estimate is that around one per cent of live births in the UK are affected.
If the severe consequences of FASD can be ameliorated by early intervention (as is the argument posited here to some extent) and, without doubt, an accurate and early diagnosis is vital to this – how can it be achieved without compounding the guilt and self-blame that a mother inevitably feels when her child is not 'normal'?
This is the issue that is sidestepped and the question I was left asking.