Foetal alcohol spectrum disorder remains a major problem in WA's Kimberley region and is a driver of the mental health problems that lead to youth suicide, a coronial inquest in to 13 suicides among Aboriginal young people has heard.
The inquest is examining a cluster of 13 deaths of Aboriginal youths in Western Australia's far north between November 2012 and March last year, including five children aged between 10 and 13, two of whom were sisters.
While all of the young people had been exposed to trauma and physical abuse, there were strong links between the behavioural and developmental problems they showed in the community and FASD, which is the result of a mother drinking alcohol during pregnancy.
As well as facial and other physical abnormalities, FASD has been linked to brain and behavioural issues including cognitive, communication, executive functioning, impulse control and other problems.
Paediatrician James Fitzpatrick and clinical neuropsychologist Carmela Pestell told the inquest about their research that had found alarming levels of heavy drinking among pregnant women in WA's far north, with more than half surveyed drinking at dangerous levels.
At least one in three young people in detention in WA had FASD and were in the bottom three per cent for cognitive function, according to a study of mostly Aboriginal male youths.
The problem of drinking during pregnancy was described as a general problem around Australia that affected various ethnic and socio-economic groups.
However the remoteness of Kimberley indigenous communities and lack of "scaffolding and structural" support services led to a greater risk that youths in those areas would not be treated for or diagnosed with FASD, leading to problems and possibly suicide, the inquest heard.
"Sadly I think FASD is one of the most potent drivers of mental health problems that lead to suicide in places like the Kimberley," said paediatrician James Fitzpatrick, an expert on the condition who says no amount of alcohol in pregnancy is safe.
"One of my great fears is that I will sitting here in 20 years talking about the same problems and solutions, that this is another in a long line of inquiries into this issue."
Just last week Dr Fitzpatrick said eight out of nine children tested in the Kimberley were diagnosed with FASD, including a boy aged less than 10 who witnessed his own mother take her life and is "verbalising this intent" about himself.
Dr Fitzpatrick described FASD as Australia's most common preventable cause of disability but it was not on the the National Disability Insurance Agency's list of recognised disabilities, preventing Medicare access to some support services.
He said there were solutions and the federal-funded "Making FASD history" project he had run in the Fitzroy Valley for six years in collaboration with families, doctors and teachers had reduced alcohol use in pregnancy by 65 per cent to 15 per cent and he would be expanding it.
