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Stubbs T, Cannon L, Carter E, Naanai H, Okurame JC, Martiniuk ALC, Davies J, Thomas S, Bedford M, Elliott EJ, Rice LJ. Fetal alcohol spectrum disorder resources for health professionals: a scoping review. BMJ Open 2024; 14:e086999. [PMID: 39002966 PMCID: PMC11253770 DOI: 10.1136/bmjopen-2024-086999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/12/2024] [Indexed: 07/15/2024] Open
Abstract
OBJECTIVES This scoping review aimed to identify and critically appraise resources for health professionals to identify, diagnose, refer, and support individuals with fetal alcohol spectrum disorder (FASD)-including the extent to which the resources are appropriate for use in communities with First Nations Peoples. METHOD Seven peer-reviewed databases (April 2022) and 14 grey literature websites (August 2022) were searched. The reference lists of all sources that underwent full-text review were handsearched, and FASD experts were consulted for additional sources. Resources were assessed using the Appraisal of Guidelines for REsearch and Evaluation II instrument and an adapted version of the National Health and Medical Research Council FORM Framework and iCAHE Guideline Quality Checklist. RESULTS A total of 41 resources underwent data extraction and critical appraisal, as screening and/or diagnosis guidelines were excluded because they are covered in other reviews. Most were recently published or updated (n=24), developed in the USA (n=15, 36.6%) or Australia (n=12, 29.3%) and assisted with FASD patient referral or support (n=40). Most management guidelines scored 76%-100% on overall quality assessment (n=5/9) and were recommended for use in the Australian context with modifications (n=7/9). Most of the guides (n=15/22) and factsheets (n=7/10) received a 'good' overall score. Few (n=3/41) resources were explicitly designed for or with input from First Nations Australians. CONCLUSION High-quality resources are available to support health professionals providing referrals and support to individuals with FASD, including language guides. Resources should be codesigned with people living with FASD to capture and integrate their knowledge and preferences.
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Affiliation(s)
- Thomas Stubbs
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- School of Public Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Lisa Cannon
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Emily Carter
- Marulu Unit, Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Habiba Naanai
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Josephine Chidinma Okurame
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Alexandra L C Martiniuk
- School of Public Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Office of the Chief Scientist, The George Institute for Global Health, Sydney, New South Wales, Australia
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada
| | - Jadnah Davies
- Marulu Unit, Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Sue Thomas
- Marulu Unit, Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Mudge Bedford
- Marulu Unit, Marninwarntikura Women’s Resource Centre, Fitzroy Crossing, Western Australia, Australia
- NDIS Remote Community Connector Team, Marra Worra Worra Aboriginal Cooporation, Fitzroy Crossing, Western Australia, Australia
| | - Elizabeth J Elliott
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network and Kid's Research, Westmead, Sydney, New South Wales, Australia
| | - Lauren J Rice
- Speciality of Child and Adolescent Health, University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Hilly C, Wilson PH, Lucas B, McGuckian TB, Swanton R, Froude EH. Effectiveness of interventions for school-aged-children and adolescents with fetal alcohol spectrum disorder: a systematic review and meta-analysis. Disabil Rehabil 2024; 46:1708-1733. [PMID: 37158227 DOI: 10.1080/09638288.2023.2207043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE To describe allied health and educational interventions and their effectiveness for children and adolescents with fetal alcohol spectrum disorder (FASD). To appraise the quality and strength of studies. METHODS Electronic databases were searched between 2005 and March 2022, identifying non-pharmacological studies supporting function, activity, or participation for FASD participants aged 5-18 years using any quantitative research design. Outcomes were coded using International Classification of Functioning, Disability and Health, family of Participation Related Constructs and behaviour categories. Multi-level random-effects meta-analysis examined intervention effects. Study methodological quality was evaluated using Cochrane risk of bias tools, RoBiNT, AMSTAR 2 and NHMRC Hierarchy levels of evidence. Certainty of findings were synthesised using GRADE approach. RESULTS The systematic review included 25 studies with 735 participants, 10 of which were analysed by meta-analysis. Body function and structure, activity, behaviour, and sense of self outcomes were pooled. A small, positive effect favouring interventions was found (g = 0.29, 95% CI = 0.15-0.43), however the GRADE certainty was rated as low. No participation outcomes were identified. CONCLUSIONS Some interventions targeting body function and structure, activity and behaviour outcomes were effective. Evidence of interventions that support children's and adolescent's participation as an outcome is lacking.
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Affiliation(s)
- Catherine Hilly
- School of Allied Health, Australian Catholic University, Canberra, Australia
| | - Peter H Wilson
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Barbara Lucas
- The John Walsh Centre for Rehabilitation Research, The University of Sydney
- Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Thomas B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural & Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Ruth Swanton
- Occupational Therapy Department, Mercy University Hospital, Cork, Ireland
- Occupational Therapy Department, South Infirmary University Hospital, Cork, Ireland
| | - Elspeth H Froude
- School of Allied Health, Australian Catholic University, Sydney, Australia
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Development and Evaluation of a Virtual Model for Fetal Alcohol Spectrum Disorder (FASD) Assessment and Diagnosis in Children: A Pilot Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020196. [PMID: 36832325 PMCID: PMC9955009 DOI: 10.3390/children10020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
The diagnostic process for fetal alcohol spectrum disorder (FASD) involves a multi-disciplinary team and includes neurodevelopmental, physical, and facial assessments and evidence of prenatal alcohol exposure during the index pregnancy. With the increased use of virtual care in health care due to the pandemic, and desire of clinics to be more efficient when providing timely services, there was a need to develop a virtual diagnostic model for FASD. This study develops a virtual model for the entire FASD assessment and diagnostic process, including individual neurodevelopmental assessments. It proposes a virtual model for assessment and diagnosis of FASD in children and evaluates the functionality of this model with other national and international FASD diagnostic teams and caregivers of children being assessed for FASD.
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Branton E, Thompson-Hodgetts S, Johnston D, Gross DP, Pritchard L. Motor skills and intelligence in children with fetal alcohol spectrum disorder. Dev Med Child Neurol 2022; 64:965-970. [PMID: 35170025 DOI: 10.1111/dmcn.15175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/27/2022]
Abstract
AIM To determine the relationship between motor abilities and intelligence in children and young people with prenatal alcohol exposure (PAE) being assessed for fetal alcohol spectrum disorder (FASD). METHOD This was a cross-sectional correlational study of children and young people with PAE being assessed for FASD. The relationship between motor abilities (Movement Assessment Battery for Children, Second Edition) and intelligence (Wechsler Intelligence Scale for Children, Fourth or Fifth Edition) was calculated using correlation and regression analyses. Attention and executive function were considered as potential confounding variables. RESULTS The relationship between motor abilities and intelligence in 73 children and young people (48 males, 25 females; aged 6-17y, mean age 10y 5mo [SD 2y 9mo]) assessed for FASD was small and statistically non-significant (r=0.05, p=0.67). INTERPRETATION The findings confirm that motor abilities and intelligence should be assessed separately when investigating an FASD diagnosis. Intelligence scores should not be used to estimate motor abilities, nor should they dictate when motor testing be completed. Assessing intelligence and motor domains separately will enhance diagnostic accuracy, identify the need for strategies or interventions to address functional motor skills, and further define the role of physiotherapy and occupational therapy in FASD assessment and intervention.
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Affiliation(s)
- Erin Branton
- Alberta Health Services, Central Zone East, Children's Rehabilitation Services, Camrose, Alberta, Canada.,Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sandy Thompson-Hodgetts
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Danielle Johnston
- Alberta Health Services, Central Zone East, Children's Rehabilitation Services, Camrose, Alberta, Canada.,Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lesley Pritchard
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Rice LJ, Tsang TW, Carter E, Hand M, Davies J, Thomas S, Bedford E, Bear E, Carter C, Cannon L, Elliott EJ. Bigiswun Kid Project: a longitudinal study of adolescents living with high rates of prenatal alcohol exposure, fetal alcohol spectrum disorder and early life trauma in remote Australian Aboriginal communities. BMJ Open 2022; 12:e058111. [PMID: 35365538 PMCID: PMC8977804 DOI: 10.1136/bmjopen-2021-058111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/16/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The Lililwan Project was the first Australian population-based prevalence study of fetal alcohol spectrum disorder (FASD) using active case ascertainment. Conducted in 2010-2011, the study included 95% of all eligible children aged 7-9 years living in the very remote Aboriginal communities of the Fitzroy Valley, Western Australia. Women from Marninwarntikura Women's Resource Centre, a local Aboriginal-led organisation, are concerned that some participants from the study are struggling in adolescence so partnered with researchers from the University of Sydney to follow up the Lililwan cohort in 2020-2022 at age 17-19 years.The overarching aim of the Bigiswun Kid Project is to identify adolescents' needs and build knowledge to inform services to improve the health and well-being of adolescents in remote Aboriginal communities. The specific aims are to: (1) provide a voice to adolescents and their families to understand the health and well-being status of the Lililwan cohort at 17-19 years. (2) Examine relationships between exposures during pregnancy, birth characteristics, and health and neurodevelopment at 7-9 years, and positive/adverse adolescent outcomes at 17-19 years. This information will identify prenatal and early life factors that predict good health and well-being in adolescence. (3) Determine whether management plans provided in the Lililwan Project were followed, and identify past and present service gaps, support needs and barriers to service use. (4) Determine if key physical characteristics of FASD change between childhood and adolescence in this Aboriginal population. ETHICS AND DISSEMINATION Approved by the Kimberley Aboriginal Health Planning Forum and relevant ethics committees.
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Affiliation(s)
- Lauren J Rice
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
| | - Emily Carter
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Marmingee Hand
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Jadnah Davies
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Sue Thomas
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Eric Bedford
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Emma Bear
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Cheyenne Carter
- Marulu Team, Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Western Australia, Australia
| | - Lisa Cannon
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney Children's Hospital Westmead Clinical School, Westmead, New South Wales, Australia
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Kar P, Reynolds JE, Grohs MN, Gibbard WB, McMorris C, Tortorelli C, Lebel C. White matter alterations in young children with prenatal alcohol exposure. Dev Neurobiol 2021; 81:400-410. [PMID: 33829663 DOI: 10.1002/dneu.22821] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 12/28/2022]
Abstract
Prenatal alcohol exposure (PAE) can lead to cognitive, behavioural, and social-emotional challenges. Previous neuroimaging research has identified structural brain alterations in newborns, older children, adolescents, and adults with PAE; however, little is known about brain structure in young children. Extensive brain development occurs during early childhood; therefore, understanding the neurological profiles of young children with PAE is critical for early identification and effective intervention. We studied 54 children (5.21 ± 1.11 years; 27 males) with confirmed PAE (94% also had other prenatal exposures, 74% had adverse postnatal experiences) compared with 54 age- and sex-matched children without PAE. Children underwent diffusion tensor imaging between 2 and 7 years of age. Mean fractional anisotropy (FA) and mean diffusivity (MD) were obtained for 10 major white matter tracts. Univariate analyses of covariance were used to test group differences (PAE vs. control) controlling for age and sex. The PAE group had higher FA in the genu of the corpus callosum and lower MD in the bilateral uncinate fasciculus. The PAE group also had lower tract volume in the corpus callosum, the bilateral inferior fronto-occipital fasciculi, and the right superior longitudinal fasciculus. Our findings align with studies of newborns with PAE reporting lower diffusivity, but contrast those in older populations with PAE, which consistently report lower FA and higher MD. Further research is needed to understand trajectories of white matter development and how our results of higher FA/lower MD in young children connect with lower FA/higher MD observed at older ages.
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Affiliation(s)
- Preeti Kar
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Jess E Reynolds
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Melody N Grohs
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - W Ben Gibbard
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Carly McMorris
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Werklund School of Education, University of Calgary, Calgary, AB, Canada
| | | | - Catherine Lebel
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
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Connor S, Tan KY, Pestell CF, Fitzpatrick JP. The Demographic and Neurocognitive Profile of Clients Diagnosed With Fetal Alcohol Spectrum Disorder in PATCHES Paediatrics Clinics Across Western Australia and the Northern Territory. Alcohol Clin Exp Res 2020; 44:1284-1291. [PMID: 32333805 DOI: 10.1111/acer.14345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorder (FASD) is a diagnosis relating to neurocognitive impairments associated with prenatal alcohol exposure. A key aspect of improving FASD diagnostic processes and management is understanding the demographic and neurocognitive profile of those living with FASD. The aim of this study was to describe the demographic and neurocognitive profile of the first 199 individuals diagnosed with FASD in PATCHES Paediatrics clinics. METHODS A retrospective cross-sectional descriptive study design was conducted with individuals diagnosed with FASD between 2013 and 2018 through a multidisciplinary team according to the Australian FASD Diagnostic Guidelines. RESULTS Participants were primarily male 133 (66.8%) and Aboriginal Australian 147 (73.9%), aged 2 to 31 (mean 10.5), with 94 (47.3%) from remote or very remote parts of Western Australia. Participants came from low 119 (59.8%), medium 48 (24.1%), and high 32 (16.1%) socioeconomic (SE) backgrounds. Low SE background was found to be a predictor of number of sentinel facial features (Wald χ2 (1) = 4.03, p < 0.05). Most received a diagnosis of FASD with <3 sentinel features 165 (82.9%). Participants either had 6 or more 46 (23.1%), 5 44 (22.1%), 4 55 (27.6%), or 3 (27.1%) neurodevelopmental domains impaired. Executive functioning was the most commonly impaired neurodevelopmental domain 158 (79.4%), and 31 (61%) reported sleep disturbance. ADHD was the most observed comorbid condition (41.7%). CONCLUSIONS This study improves our current understanding of neurocognitive and demographic profiles in individuals with FASD that have been clinically referred for diagnosis within Western Australia and the Northern Territory, and highlights the importance of prevention and early assessment/diagnosis as well as guidance regarding more targeted interventions. FASD affects individuals from all cultural and SE backgrounds. Individuals from middle to higher SE groups are at risk of FASD with prevention efforts needing to target these sectors of society. Suggestions for future research directions are also provided.
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Affiliation(s)
- Sophia Connor
- The University of Western Australia, (SC, KYT, CFP, JPF), Crawley, Western Australia, Australia.,PATCHES Paediatrics, (SC, KYT, CFP, JPF), Nedlands, Western Australia, Australia
| | - Kuen Yee Tan
- The University of Western Australia, (SC, KYT, CFP, JPF), Crawley, Western Australia, Australia.,PATCHES Paediatrics, (SC, KYT, CFP, JPF), Nedlands, Western Australia, Australia.,Telethon Kids Institute (TKI), (KYT, CFP, JPF), Nedlands, Western Australia, Australia
| | - Carmela F Pestell
- The University of Western Australia, (SC, KYT, CFP, JPF), Crawley, Western Australia, Australia.,PATCHES Paediatrics, (SC, KYT, CFP, JPF), Nedlands, Western Australia, Australia.,Telethon Kids Institute (TKI), (KYT, CFP, JPF), Nedlands, Western Australia, Australia
| | - James P Fitzpatrick
- The University of Western Australia, (SC, KYT, CFP, JPF), Crawley, Western Australia, Australia.,PATCHES Paediatrics, (SC, KYT, CFP, JPF), Nedlands, Western Australia, Australia.,Telethon Kids Institute (TKI), (KYT, CFP, JPF), Nedlands, Western Australia, Australia
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Blanck-Lubarsch M, Dirksen D, Feldmann R, Sauerland C, Hohoff A. Tooth Malformations, DMFT Index, Speech Impairment and Oral Habits in Patients with Fetal Alcohol Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224401. [PMID: 31717945 PMCID: PMC6888578 DOI: 10.3390/ijerph16224401] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 12/17/2022]
Abstract
Background: Fetal alcohol spectrum disorder (FASD) is a developmental disorder with severe negative lifetime consequences. Although knowledge about the harmfulness of alcohol consumption during pregnancy has spread, the prevalence of fetal alcohol spectrum disorder is very high. Our study aims at identifying fetal alcohol syndrome (FAS)-associated dental anomalies or habits, which need early attention. Methods: Sixty children (30 FAS; 30 controls) were examined prospectively. Swallowing pattern, oral habits, breastfeeding, speech therapy, ergotherapy, physiotherapy, exfoliation of teeth, DMFT (decayed, missing, filled teeth) index, modified DDE (developmental defects of enamel) index and otitis media were recorded. Results: Swallowing pattern, exfoliation of teeth, and otitis media were not significantly different. Significant differences could be found concerning mouthbreathing (p = 0.007), oral habits (p = 0.047), age at termination of habits (p = 0.009), speech treatment (p = 0.002), ergotherapy, physiotherapy, and breastfeeding (p ≤ 0.001). DMFT (p ≤ 0.001) and modified DDE (p = 0.001) index showed significantly higher values for children with fetal alcohol syndrome. Conclusions: Children with fetal alcohol syndrome have a higher need for early developmental promotion such as speech treatment, ergotherapy, and physiotherapy. Mouthbreathing, habits, and lack of breastfeeding may result in orthodontic treatment needs. High DMFT and modified DDE indexes hint at a higher treatment and prevention need in dentistry.
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Affiliation(s)
- Moritz Blanck-Lubarsch
- Department of Orthodontics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
- Correspondence: ; Tel.: +49-0251-83-47100
| | - Dieter Dirksen
- Department of Prosthodontics and Biomaterials, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Reinhold Feldmann
- Department of Pediatrics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
| | - Cristina Sauerland
- Institute of Biostatistics and Clinical Research, University of Münster, Schmeddingstraße 56, 48149 Münster, Germany;
| | - Ariane Hohoff
- Department of Orthodontics, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany;
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Dossetor PJ, Thorburn K, Oscar J, Carter M, Fitzpatrick J, Bower C, Boulton J, Fitzpatrick E, Latimer J, Elliott EJ, Martiniuk AL. Review of Aboriginal child health services in remote Western Australia identifies challenges and informs solutions. BMC Health Serv Res 2019; 19:758. [PMID: 31655576 PMCID: PMC6815358 DOI: 10.1186/s12913-019-4605-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities. We aimed to identify and map child health services in the very remote Fitzroy Valley, West Kimberley, and document barriers to effective service delivery. METHODS Identification and review of all regional child health services and staffing in 2013. Verification of data by interview with senior managers and staff of key providers in the Western Australian Country Health Service, Kimberley Population Health Unit, Nindilingarri Cultural Health Services and non-government providers. RESULTS We identified no document providing a comprehensive overview of child health services in the Fitzroy Valley. There were inadequate numbers of health professionals, facilities and accommodation; high staff turnover; and limited capacity and experience of local health professionals. Funding and administrative arrangements were complex and services poorly coordinated and sometimes duplicated. The large geographic area, distances, extreme climate and lack of public and private transport challenge service delivery. The need to attend to acute illness acts to deprioritise crucial primary and preventative health care and capacity for dealing with chronic, complex disorders. Some services lack cultural safety and there is a critical shortage of Aboriginal Health Workers (AHW). CONCLUSIONS Services are fragmented and variable and would benefit from a coordinated approach between government, community-controlled agencies, health and education sectors. A unifying model of care with emphasis on capacity-building in Aboriginal community members and training and support for AHW and other health professionals is required but must be developed in consultation with communities. Innovative diagnostic and care models are needed to address these challenges, which are applicable to many remote Australian settings outside the Fitzroy Valley, as well as other countries globally. Our results will inform future health service planning and strategies to attract and retain health professionals to work in these demanding settings. A prospective audit of child health services is now needed to inform improved planning of child health services with a focus on identifying service gaps and training needs and better coordinating existing services to improve efficiency and potentially also efficacy.
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Affiliation(s)
- Philippa J Dossetor
- Clinical Medical School, College of Medicine, Biology & Environment, Australian National University, ACT, Canberra, 2605, Australia.
| | - Kathryn Thorburn
- Nulungu Research Institute, University of Notre Dame, Broome, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Crossing, Fitzroy, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Crossing, Fitzroy, Australia
| | - James Fitzpatrick
- University of Sydney, Sydney Medical School, Sydney, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Carol Bower
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | | | - Emily Fitzpatrick
- University of Sydney, Sydney Medical School, Sydney, Australia.,The Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Jane Latimer
- University of Sydney, Sydney Medical School, Sydney, Australia
| | - Elizabeth J Elliott
- University of Sydney, Sydney Medical School, Sydney, Australia.,The Sydney Children's Hospital Network (Westmead), Sydney, Australia
| | - Alexandra Lc Martiniuk
- University of Sydney, Sydney Medical School, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia.,The University of Toronto, Toronto, Canada
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10
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Johnston D, Branton E, Rasmuson L, Schell S, Gross DP, Pritchard-Wiart L. Accuracy of motor assessment in the diagnosis of fetal alcohol spectrum disorder. BMC Pediatr 2019; 19:171. [PMID: 31138161 PMCID: PMC6537401 DOI: 10.1186/s12887-019-1542-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 05/17/2019] [Indexed: 11/10/2022] Open
Abstract
Background To evaluate the accuracy of motor assessment tools listed in Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan (Canadian Guideline) for the purpose of fetal alcohol spectrum disorder (FASD) diagnosis. Specifically, we aimed to determine: 1) diagnostic accuracy of motor assessment tools and subtests; 2) accuracy of multiple subtests versus total scores; and 3) accuracy of alternate cut-offs. Methods Cross-sectional diagnostic study of 63 children aged 6–17 years. Diagnostic accuracy and alternate cut-offs were calculated for the Movement Assessment Battery for Children, 2nd edition (MABC-2), Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition Short Form (BOT-2SF) and Beery-Buktenica Developmental Test of Visual Motor Integration, 6th edition (BeeryVMI-6). Results The MABC-2 total motor score was more sensitive (0.30; 95% CI 0.17–0.46; p < 0.01) to motor impairment in the presence of FASD than the BOT-2SF (0.02; 95% CI 0.00–0.12) at the 2nd percentile (−2SD). The MABC-2 total motor score was more accurate than any combination of subtest scores. The Motor Coordination subtest of the BeeryVMI-6 (BeeryMC) at the 5th percentile (− 1.5SD) (sensitivity 0.68, specificity 0.90) was the most accurate subtest. Conclusions The BOT-2SF was an inaccurate assessment tool for FASD diagnosis. The MABC-2 total motor score was the most accurate using current guidelines, though its sensitivity was still low. Further investigation into inclusion of single subtests and/or using a less conservative cut-off in the Canadian Guideline is warranted.
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Affiliation(s)
- Danielle Johnston
- Alberta Health Services, Central Zone East, Children's Rehabilitation Services, Professional Centre, Suite 300, 5015 50 Ave, Camrose, Alberta, T4V 3P7, Canada.
| | - Erin Branton
- Alberta Health Services, Central Zone East, Children's Rehabilitation Services, Professional Centre, Suite 300, 5015 50 Ave, Camrose, Alberta, T4V 3P7, Canada
| | - Leah Rasmuson
- Alberta Health Services, Central Zone East, Children's Rehabilitation Services, Professional Centre, Suite 300, 5015 50 Ave, Camrose, Alberta, T4V 3P7, Canada
| | - Sylvia Schell
- Alberta Health Services, Central Zone East, Children's Rehabilitation Services, Professional Centre, Suite 300, 5015 50 Ave, Camrose, Alberta, T4V 3P7, Canada
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, T6G 2G4, Canada
| | - Lesley Pritchard-Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, Edmonton, Alberta, T6G 2G4, Canada
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11
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Doney R, Lucas BR, Watkins RE, Tsang TW, Sauer K, Howat P, Latimer J, Fitzpatrick JP, Oscar J, Carter M, Elliott EJ. Fine motor skills in a population of children in remote Australia with high levels of prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder. BMC Pediatr 2017; 17:193. [PMID: 29157212 PMCID: PMC5696768 DOI: 10.1186/s12887-017-0945-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many children in the remote Fitzroy Valley region of Western Australia have prenatal alcohol exposure (PAE). Individuals with PAE can have neurodevelopmental impairments and be diagnosed with one of several types of Fetal Alcohol Spectrum Disorder (FASD). Fine motor skills can be impaired by PAE, but no studies have developed a comprehensive profile of fine motor skills in a population-based cohort of children with FASD. We aimed to develop a comprehensive profile of fine motor skills in a cohort of Western Australian children; determine whether these differed in children with PAE or FASD; and establish the prevalence of impairment. METHODS Children (n = 108, 7 to 9 years) were participants in a population-prevalence study of FASD in Western Australia. Fine motor skills were assessed using the Bruininks-Oseretsky Test of Motor Proficiency, which provided a Fine Motor Composite score, and evaluated Fine Manual Control (Fine Motor Precision; Fine Motor Integration) and Manual Coordination (Manual Dexterity; Upper-Limb Coordination). Descriptive statistics were reported for the overall cohort; and comparisons made between children with and without PAE and/or FASD. The prevalence of severe (≤ 2nd percentile) and moderate (≤16th percentile) impairments was determined. RESULTS Overall, Fine Motor Composite scores were 'average' (M = 48.6 ± 7.4), as were Manual Coordination (M = 55.7 ± 7.9) and Fine Manual Control scores (M = 42.5 ± 6.2). Children with FASD had significantly lower Fine Motor Composite (M = 45.2 ± 7.7 p = 0.046) and Manual Coordination scores (M = 51.8 ± 7.3, p = 0.027) than children without PAE (Fine Motor Composite M = 49.8 ± 7.2; Manual Coordination M = 57.0 ± 7.7). Few children had severe impairment, but rates of moderate impairment were very high. CONCLUSIONS Different types of fine motor skills should be evaluated in children with PAE or FASD. The high prevalence of fine motor impairment in our cohort, even in children without PAE, highlights the need for therapeutic intervention for many children in remote communities.
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Affiliation(s)
- Robyn Doney
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Barbara R Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
| | - Rochelle E Watkins
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Kay Sauer
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Australia
| | - Peter Howat
- School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Australia
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia.,University of Notre Dame, Broome, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,The Sydney Children's Hospitals Network (Westmead), Sydney, Australia
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12
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Behavior in Children with Fetal Alcohol Spectrum Disorders in Remote Australia: A Population-Based Study. J Dev Behav Pediatr 2017; 38:528-537. [PMID: 28604500 DOI: 10.1097/dbp.0000000000000463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To document behavior in children residing in very remote Western Australian communities as rated by parent/caregivers and teachers. We hypothesized that children with fetal alcohol spectrum disorders (FASD) would have higher rates of problematic behavior than children without FASD. METHODS The Child Behavior Checklist (CBCL; n = 97), and Teacher Report Form (TRF; n = 106) were used in this population-based study. Raw scores, proportions scoring within "Normal/Borderline/Clinical" ranges, and frequencies of Critical items were determined. Mann-Whitney U and χ tests were used for between-group comparisons. RESULTS Children were aged from 7.5 to 9.6 years, and 19% had FASD. Academic performance was commonly rated in the "Borderline/Clinical" range (73%). Teacher-rated scores were poorer in the FASD group on 15 scales encompassing total and internalizing problems, adaptive function, academic performance, attention, withdrawn/depressed, social problems, posttraumatic stress, thought problems, and sluggish cognitive tempo (p < .05). More children in the FASD group had scores in the "Borderline/Clinical" range on 11 TRF scales (p < .05). "Physically attacks people" was the most prevalent Critical item endorsed by teachers for the total cohort (22%). "Talks about killing self" was endorsed by teachers more often in the FASD group (14%) than the Non-FASD group (1%; p = .03). There were no significant differences between groups in parent-reported CBCL scores after adjustment for multiple comparison testing. CONCLUSION This study demonstrates that children with FASD have more teacher-reported behavioral impairment than children without FASD. In remote Australian communities, academic performance is poor.
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13
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Lucas BR, Latimer J, Doney R, Watkins RE, Tsang TW, Hawkes G, Fitzpatrick JP, Oscar J, Carter M, Elliott EJ. Gross motor performance in children prenatally exposed to alcohol and living in remote Australia. J Paediatr Child Health 2016; 52:814-24. [PMID: 27439995 DOI: 10.1111/jpc.13240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2016] [Indexed: 11/27/2022]
Abstract
AIM This study aimed to determine the gross motor (GM) performance of Aboriginal children living in remote Australia. The relationship between GM skills, prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders (FASD) was explored. METHODS A population-based observation study was conducted in 2011 to assess motor performance in children living in the Fitzroy Valley, Western Australia, using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2). BOT-2 data were retrospectively analysed using recently developed software enabling separation of fine and GM outcomes. RESULTS A total of 108 children (98.1% Aboriginal; 53% male, mean age: 8.7 years) were assessed. Half (52.2%) were exposed to at least 'risky' levels of PAE, and 21 (19%) were diagnosed with an FASD. The mean GM composite score of the cohort (47.0 ± 8.4) approached the BOT-2 normative mean (50.0 ± 10) and was similar between children with and without PAE (P = 0.27). This mean score, however, was significantly lower in children with FASD than without (mean difference: -5.5 ± 20.6; P = 0.006). Compared with children without FASD, children with FASD had significant impairment in subtests for running speed and agility (mean difference ± standard deviation (SD): -2.4 ± 8.1; P = 0.003) and strength (mean difference ± SD:-2.8 ± 9.9; P = 0.004) and (ii) a higher proportion than expected had overall GM impairment (≤2 SD: 9.5%; ≤1 SD: 23.8%). In groups with PAE, no PAE and no FASD, GM function approached expected population norms. CONCLUSIONS A higher than expected proportion of children with FASD had GM scores that indicated impairment and need for therapy. Evaluation of GM performance should routinely be included in FASD assessment to determine strategies to optimise child development.
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Affiliation(s)
- Barbara R Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Poche Centre for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Physiotherapy Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jane Latimer
- The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Robyn Doney
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Rochelle E Watkins
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Genevieve Hawkes
- Derby Allied Health Service, Western Australian Country Health Services, Perth, Western Australia, Australia
| | - James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Perth, Western Australia, Australia.,University of Notre Dame, Broome, Western Australia, Australia
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Kimberley, Western Australia, Australia
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Musculoskeletal Division, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.,University of Notre Dame, Broome, Western Australia, Australia.,The Sydney Children's Hospital Networks (Westmead), Sydney, New South Wales, Australia
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14
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Doney R, Lucas BR, Watkins RE, Tsang TW, Sauer K, Howat P, Latimer J, Fitzpatrick JP, Oscar J, Carter M, Elliott EJ. Visual-motor integration, visual perception, and fine motor coordination in a population of children with high levels of Fetal Alcohol Spectrum Disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 55:346-357. [PMID: 27228005 DOI: 10.1016/j.ridd.2016.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/09/2016] [Accepted: 05/10/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Visual-motor integration (VMI) skills are essential for successful academic performance, but to date no studies have assessed these skills in a population-based cohort of Australian Aboriginal children who, like many children in other remote, disadvantaged communities, consistently underperform academically. Furthermore, many children in remote areas of Australia have prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD), which are often associated with VMI deficits. METHODS VMI, visual perception, and fine motor coordination were assessed using The Beery-Buktenica Developmental Test of Visual-Motor Integration, including its associated subtests of Visual Perception and Fine Motor Coordination, in a cohort of predominantly Australian Aboriginal children (7.5-9.6 years, n=108) in remote Western Australia to explore whether PAE adversely affected test performance. Cohort results were reported, and comparisons made between children i) without PAE; ii) with PAE (no FASD); and iii) FASD. The prevalence of moderate (≤16th percentile) and severe (≤2nd percentile) impairment was established. RESULTS Mean VMI scores were 'below average' (M=87.8±9.6), and visual perception scores were 'average' (M=97.6±12.5), with no differences between groups. Few children had severe VMI impairment (1.9%), but moderate impairment rates were high (47.2%). Children with FASD had significantly lower fine motor coordination scores and higher moderate impairment rates (M=87.9±12.5; 66.7%) than children without PAE (M=95.1±10.7; 23.3%) and PAE (no FASD) (M=96.1±10.9; 15.4%). CONCLUSIONS Aboriginal children living in remote Western Australia have poor VMI skills regardless of PAE or FASD. Children with FASD additionally had fine motor coordination problems. VMI and fine motor coordination should be assessed in children with PAE, and included in FASD diagnostic assessments.
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Affiliation(s)
- Robyn Doney
- School of Public Health, Curtin University, Perth, Australia.
| | - Barbara R Lucas
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; Poche Center for Indigenous Health, Sydney Medical School, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia.
| | - Rochelle E Watkins
- Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - Tracey W Tsang
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia.
| | - Kay Sauer
- School of Public Health, Curtin University, Perth, Australia; Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Australia.
| | - Peter Howat
- School of Public Health, Curtin University, Perth, Australia; Centre for Behavioural Research in Cancer Control, Curtin University, Perth, Australia.
| | - Jane Latimer
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia.
| | - James P Fitzpatrick
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; Telethon Kids Institute, University of Western Australia, Perth, Australia.
| | - June Oscar
- Marninwarntikura Women's Resource Centre, Fitzroy Crossing, Australia; University of Notre Dame, Broome, Australia.
| | - Maureen Carter
- Nindilingarri Cultural Health Services, Fitzroy Crossing, Australia.
| | - Elizabeth J Elliott
- Discipline of Paediatrics and Child Health, Sydney Medical School, The University of Sydney, Sydney, Australia; The George Institute for Global Health, Sydney Medical School, The University of Sydney, Australia; The Sydney Children's Hospitals Network (Westmead), Sydney, Australia.
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