Fetal Alcohol Spectrum Disorder Assessments

Fetal Alcohol Spectrum Disorder

General Information

FASD is a lifelong condition and is more common than Autism. If undiagnosed, people could observe behaviours commonly seen in young people diagnosed with ADHD and Autism. Attachment difficulties, traumatic experiences and/or behaviours observed with young people diagnosed with DLD or Learning Difficulties can also be observed.

When foetal alcohol syndrome (FAS) was initially described, diagnosis was based upon physical parameters including facial anomalies and growth problems, with evidence of developmental delay or cognitive deficiency. Forty years of research has shown that FASD lies towards the extreme end of what are now termed foetal alcohol spectrum disorders (FASD). The most profound effects of prenatal alcohol exposure are on the developing brain and the cognitive and behavioural effects that ensue. Alcohol exposure affects brain development via numerous pathways at all stages of development. For example, the same processes that give rise to the facial characteristics of FAS also cause abnormal brain development. Behaviours as diverse as executive functioning to motor control are affected.

The neurodevelopmental deficits associated with FASD are complex and multifaceted: Learning disabilities, inattention, memory problems, social and emotional dysregulation, executive function deficits ets can occur regardless of facial dysmorphology.

Formal assessments, diagnosis and descriptors of FASD can help the individual, their family and/or carers as well as service providers to understand the associated challenges and vulnerabilities that require adaptations, support and understanding to reduce harm and maximise success.

Diagnosis at the early stages of development allow early intervention and treatment programmes thus ensuring better overall outcomes. Assessment and diagnosis at later stages of life identify vulnerabilities and offer clearer direction for support and treatment thus enabling independence, development of adaptive skills as well as ensuring appropriate support and prevention of harm are in place.

Assessment and diagnosis should be Multidisciplinary, and assessment needed are often multifaceted but needs to be planned and carried out based on individual need:

Medical and developmental assessment may evaluates …… and blood tests that can identify need for further genetic testing.
Neurodevelopmental, neuropsychological and neurocognitive assessment can evaluate adaptive planning, memory, learning capacity and executive functioning.
Comprehension and use of language as well as metalinguistic assessment evaluate understanding, processing and use of language, working memory and executive functioning such as figurative language, idioms and sarcasm, pragmatic understanding and use of language etc.
Behavioural assessment and sensory integration evaluation conducted by specially trained Occupational Therapist, highlight areas of sensory challenges and can provide activities for home and school that help support sensory issues (sensory diet).

SIGN (2019); Chudley et al

NICE Quality Standards on FASD (2020)

Assessment Process - How is Diagnosis Made

Firstly, the confirmation is made of alcohol-exposed pregnancy (PAE) or young person exposed to alcohol prenatally. Sometimes this is confirmed by a review of maternal records.

Scottish SIGN guidelines have been accepted by NICE as the basis for the upcoming NICE Quality Standard on FASD. Confirmation of PAE requires documentation that biological mother consumed alcohol during pregnancy based on:-

Reliable clinical observation
Self-report by a reliable source
Medical records documenting positive blood alcohol concentration
Alcohol treatment or other social, legal or medical problems related to drinking during pregnancy.

NB: a diagnosis of FASD is possible without confirmation of alcohol-exposed pregnancy when three sentinel facial features are present (<10%).

There does not have to be an absolute positive intake history to make a diagnosis of FASD. If the practitioner/professional team feel they have a circumstantial history OR they could put the patient into the ‘at risk’ of FASD group.

SEN Professionals provide local services in Kent to evaluate children and young people with potential FASD.

Parents/Carers and Social Workers are advised to speak with GP and SENCO at the young person’s educational setting, prior to initiating a referral, in order to obtain all health and education information available.

It is essential to point out that diagnosing FASD is a complex, lengthy process and requires specialist expertise and clinical experience.

Assessment Pathway

Phase 1

Online Interview and Information Collating

Evaluation typically involves lengthy online interview with Foster Parent, Carer and/or Social Worker to collate background information. Digital copies of any relevant previous Health, Social and Education Reports are requested eg: paediatrician, hospital release letter, audiology etc.

Phase 2

Multidisciplinary Assessment

Once all available background information is collated, face-to-face appointment is offered at our clinic in Ash - ‘The Black Barn’. This typically involves a whole day appointment and involves a Multidisciplinary Team. These specialist clinicians can include Consultant Community Paediatrician, Consultant Clinical Psychologist and/or Specialist Speech and Language Therapist, Occupational Therapist. The team is assembled based on need that is evaluated during Phase 1.

Phase 3

Optional Additional Assessments

If clinical evaluation and diagnostic outcome(s) during Phase 1 and 2 suggest additional assessments are required, SEN Professionals can provide Neurodevelopmental Assessment for Autism, ADHD , Dyslexia, Developmental Language Disorder etc.