Do you know what Fetal Alcohol Spectrum Disorder is and how it impacts on your job
by Elizabeth Russell- Russell Family Foetal Alcohol Disorders Association
I'm sure you have heard of Fetal Alcohol Spectrum Disorder (FASD) and the issues related to education, mental health, drug and alcohol addictions, offending and the criminal justice system, behaviour and diagnosis. FASD prevalence studies from overseas (we don’t have our own yet) seem to indicate that there are around one million people in Australia who, if they were to be diagnosed, would be found to have FASD. Education is in a unique position where schools will be teaching students with undiagnosed FASD throughout childhood and adolescence.
It will be difficult for teachers to manage students with the physical brain injury that is FASD without understanding that the sensory processing, mental illness, learning disabilities, speech problems and behaviour are not within the control of the student. It would be much easier for both teacher and student if the teachers were trained in the identification and interventions required for people with FASD. Evidence based teaching specifically developed for neuro-typical students will leave children with FASD behind and create more behavioural issues in the classroom. Because students with FASD whether diagnosed or not do not have neuro-typical brains. They require a different teaching approach. This approach will not ‘hurt’ children without FASD but will make a big difference to the learning and behaviour of people with this condition.
Doctors, psychiatrists and psychologists should be aware of the criteria for the diagnosis of full Fetal Alcohol Syndrome which is less complex to diagnose because of the typical facial anomalies. Diagnosis of FAS requires four criteria:
- Confirmed prenatal exposure to alcohol
- CNS damage
- Three facial anomalies – a) flat philtrum b) thin upper lip, and c) short palpebral fissures
- Growth retardation
Particularly in Australia, because FASD is rarely diagnosed, people with FASD will develop secondary disabilities through frustration and disappointments secondary to the primary disability, the brain injury. This typically occurs during young adolescence. Children with FASD are expected to manage school life (social and academic) in the way that a neuro-typical student might, and continually ‘fail’. They will be the students who are in the Principal’s office over and over again and seem not to learn from their mistakes. Secondary disabilities such as mental health problems, substance abuse, trouble with the police, expulsion or suspension, leaving school early and other issues can be prevented or alleviated if the people around the student with FASD understands that he or she has a physical brain based condition. They are likely to be referred for a diagnosis of ADHD, Autism or Asperger’s. These conditions are often misdiagnosed instead of FASD or they are co-morbid to FASD.
For example, do you know anyone with the following history?
- Learning problems at school
- Significant behavioural problems
- Have been diagnosed with ADHD, ADD, ODD, RAD, or other ’alphabet soup’ type diagnoses
- Suspended or expelled from school
- Not doing well academically even though they seem quite intelligent
- Can talk very well
- Using drugs and|or alcohol
- Agree with you or nod they understand but you get the feeling its only because they want to get out of your office not because they really understand
- Have been in trouble with the police
- May have a history of inappropriate sexual behaviour
- Suicide ideation
- Don’t do their homework
- Truancy regularly
- Can be angry and violent
- Have depression |anxiety but are also very difficult to diagnose because they can be observed to be depressed and suicidal one day yet happy the next
- When one thing goes wrong “everything is wrong”
- Seem immature when stressed or under pressure
- Have a dysfunctional family environment where mum and dad both use drugs or alcohol (this is not necessarily the case with children with FASD because the majority of mothers with children with FASD will be social drinkers - if we can identify children of alcoholic parents at least, we can help some students)
If you can relate to this history, then you may know a child or adolescent with undiagnosed FASD. But how do you help them? What sort of programs will work for people with FASD?
The rffada is a charity but we have partnered with a for profit registered training organisation called Training Connections Australia which provides training on FASD along with ideas on interventions and strategies that you can use to support and help people with FASD. The rffada believes that eventually training on FASD will become mandatory for teachers, service providers and others because of the susceptibility of children to develop secondary disabilities when they are treated as though they have a neuro-typical brain. The Secondary Disabilities can often be more difficult and life threatening than the primary disability.
The following is a list of referral options:
- Refer to Gold Coast FASD Diagnostic Clinic – takes only children between 0 – 10 – team leader is Dr Doug Shelton, MB BS, Dip Paed, FRACP, Clinical Director | Community Child Health, Medical Director | Children's Health Services, Community Child Health, Southport Health Precinct, 16-30 High St, Southport 4215, P: 07 5687 9183| F: 07 5687 9163M: 0410 433 038P: 1300 744 284 E: firstname.lastname@example.org. If you have older children, Doug will keep them on a registerand when they have psych students they will be assessed. This is hit and miss as they don't always have students. But it does give them ammunition to argue for more services.
- Dr Kerryn Bagley – 0452 210 001 and email address is email@example.com
- Dr Elizabeth Elliott, Westmead Hospital FASD Clinic
Additionally, the rffada has developed an informal NON-MEDICAL SCREENING TOOL to identify people with FASD. The questions in this tool are based on my research both personal and academic into the condition over the last 15 years as well as my experience as the mother of two children with FASD. The material in this form offers information only and is not evidence-based. Only a doctor can give medical advice and | or make a diagnosis. FASD can vary in severity and affect those with the disorder throughout their lives. Some people may have just one or two problems; others may have many. The types of problems experienced by people with FASD can also change as they become older. A positive response to all questions in the screening tool still may not mean FASD as there are other conditions which also have these same signs, symptoms and history. However if it looks and sounds like FASD treat it like FASD and use FASD-friendly interventions and strategies. This may help the individual avoid secondary disabilities.
If you would like a copy of the SCREENING TOOL, please email me on firstname.lastname@example.org and if you would like more information about our training please contact me via email or on 0412 550 540.
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