FAS/FASD (Fetal Alcohol Syndrome/Fetal Alcohol Spectrum Disorder) This is a preventable condition The evidence is strong on the link between alcohol intake in pregnancy, and FAS/FASD This is a lifelong condition, which can occur with or without dysmorphology (physical characterstics), but always with cognitive impairment (Self- regulation, Adaptive functioning)
Key learning from Manitoba Early identification is crucial to support children and their families (including adoptive families) to have the best outcomes they can Good capture of pre-natal alcohol use is imperative to getting a correct diagnosis Community understanding for families with this diagnosis is critical to prevent harm
Core Messaging Scotland is the only country in the UK to say no alcohol no risk Clear, consistent messages on alcohol intake during pregnancy at every contact Better understanding of the impact of FAS/FASD on child behaviours, even where there is more than one condition present Making the alcohol question part of routine enquiry Working on principle that every mother wants the best for their child, and do not deliberately set out to cause harm We need to identify scale of need, working sensitively with children and families Prevention begins in schools, working with potential mothers and fathers of the future
Neurobehavioural Challenges in FASD Across the Lifespan Self-regulation Attention Learning Communication Organization and Judgment Recall and memory Adaptive functioning
Common Symptoms in Infancy Excessive arousal Sleep problems Short attention Developmental delay Motor abnormalities-delay, abnormal quality Abnormalities in tone, reflexes Atypical sensory responsivity
Common Symptoms in Preschool Years Hyperactivity Attention problems Language delay Motor incoordination Atypical sensory responsivity Aggression Abnormal memory Delayed play skills
Common Symptoms in School Age Children Attention deficit, impulsivity, hyperactivity Memory problems (home, school) Behavior problems easily over-stimulated problems with transitions falsehoods Problems with peer friendships - difficulties with social judgment Learning disability
Common Symptoms in Adolescence/Adult Working memory deficits Severe language impairment Sensory issues often overlooked Gaps in thinking process difficulty forming associations, predicting, abstract reasoning, cause and effect, generalization Learning disability Impulsivity and distractibility Difficulty managing free time Difficulty with judgments ie. weighing and evaluating difficulty understanding safety and danger heightened risk of exploitation and victimization Difficulty managing time, money, and schedules Social dysmaturity External supports needed for success
Common Developmental Profile for Adolescent with FASD (Diane Malbin, 2002) Chronologic Age 18 years Expressive language Social Maturity Math Skills Reading Decoding Reading Comprehension 23 years 12 Years 8 years 14 years 9 years
Current Activity FASD clinic in Manitoba have shared their diagnostic pathway using an evidence based diagnostic tool for assessment, NHS teams have been trained FASD elearning on NES Knowledge Network http://www.nes.scot.nhs.uk/education-andtraining/by-theme-initiative/maternitycare/about-us/current-projects/fetalalcohol.aspx Core pathway for Scotland has been developed
Testing the Scottish FASD Pathway NHS Ayrshire and Arran are being funded to test the diagnostic pathway; This will include an iterative evaluation on key components: Awareness raising of risks associated with pre-natal exposure to alcohol Training of early years workforce, particularly focussed on midwives/hv s/education to make asking about alcohol routine Data capture system on throughput Diagnostic assessment Child and family specific interventions post diagnosis Community supports post diagnosis
Without FASD Dx and Support (Streissguth, 1997) Individual Risks Unemployment Loss of family Homelessness Juvenile justice involvement Premature death Substance abuse Mental health School failure Family Risks Loss of family Increased substance use Premature death Financial strain Emotional stress
FASD Toolkit http://www.scotland.gov.uk/publications/ 2013/10/3881