Fetal alcohol spectrum disorders: notifications to the Western Australian Register of Developmental Anomalies

An evaluation of a multi-site fetal alcohol spectrum disorder models of care project

Fetal alcohol spectrum disorder (FASD) continues to be underdiagnosed in Australia, partly due to the lack of trained clinicians and diagnostic services. This project aimed to help increase FASD knowledge and diagnostic capacity across Australia. Six sites across Australia formed part of a national consortium, delivering training clinics, diagnostic clinics and community education sessions. The number of FASD diagnoses significantly increased across the project. Additionally, the number of community education sessions steadily increased across the project, with largely positive feedback. Participants attending the training clinics demonstrated increased knowledge of and confidence in FASD diagnosis. This evaluation showcases the benefits of a coordinated approach to prevention, assessment, diagnosis and training in FASD.

Adverse childhood experiences, associated stressors and comorbidities in children and youth with fetal alcohol spectrum disorder across the justice and child protection settings in Western Australia

Background

Individuals with Fetal Alcohol Spectrum Disorder (FASD) are at risk of having adverse childhood experiences (ACEs), especially those with child protection and/or justice system involvement. The complex relationship between FASD and psychosocial vulnerabilities in the affected individual is an important clinical risk factor for comorbidity. This study (1) explored the ACEs and associated stressors in individuals with FASD; (2) investigated the association between ACEs and negative outcomes, i.e., justice/child protection system involvement; and (3) examined the relationship between ACEs and comorbid conditions such as mood and neurodevelopmental disorders.

Methods

Data were collected retrospectively via file review from diagnostic clinics in Western Australia. Life adversity was coded using a standardised ACEs questionnaire. A total of 211 participants (72% males) with FASD with a mean age of 11 years (range = 2–21) were included in the final sample. 70% of the total sample had been involved with the child protection system and 40% had trouble with the law.

Results

Exposure to drinking/substance misuse at home (70%) and domestic violence (52%) were the two most common ACEs across the total sample. In the entire cohort, 39% had four or more ACEs, indicating higher risks of poor health outcomes. Additional stressors recorded were disengagement from school (43%), transiency (19%), victims of bullying (12%), traumatic brain injury (9%) and homelessness (5%). ACEs such as drinking/substance misuse at home, emotional neglect and physical neglect were positively associated with child protection system involvement. Additionally, exposure to domestic violence was positively correlated with justice system involvement. Higher rates of life adversity in this clinical population were associated with an increased number of comorbidities. Specifically, those with FASD who had comorbidities such as attachment disorder, substance use disorder, and PTSD also reported higher ACEs scores.

Conclusion

ACEs were common in this clinical population. Increased ACEs in this sample were associated with increased comorbidities and involvement with the child protection and/or justice system. This highlights that prevention, intervention and early diagnosis of FASD are important for at risk children to reduce the negative effects of ACEs.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03654-y.

Exploring offending characteristics of young people with foetal alcohol spectrum disorder in Western Australia

Neurodevelopmental impairments resulting from Foetal Alcohol Spectrum Disorder (FASD) can increase the likelihood of justice system involvement. This study compared offence characteristics in young people with FASD to demographically matched controls (n = 500) in Western Australia. A novel approach (i.e. association rule mining) was adopted to uncover relationships between personal attributes and offence characteristics. For FASD participants (n = 100), file records were reviewed retrospectively. Mean age of the total sample was 15.60 years (range = 10-24), with 82% males and 88% Australian Aboriginal. After controlling for demographic factors, regression analyses showed FASD participants were more likely than controls to be charged with reckless driving (odds ratio, OR = 4.20), breach of bail/community orders (OR = 3.19), property damage (OR = 1.84), and disorderly behaviour (OR = 1.54). Overall, our findings suggest justice-involved individuals with FASD have unique offending profiles. These results have implications for sentencing, diversionary/crime prevention programs and interventions.

Birth prevalence of congenital heart defects in Western Australia, 1990-2016

AIM

To describe the birth prevalence and characteristics of congenital heart defects in a geographically defined Australian population.

METHODS

This descriptive, population-based study examined congenital heart defects in live births, stillbirths and pregnancy terminations ascertained by the Western Australian Register of Developmental Anomalies, 1990-2016. Birth prevalence (per 1000 births) was stratified by severity, known cause, maternal and birth characteristics, and primary diagnosis; and prevalence ratios were calculated for Aboriginal versus non-Aboriginal births. Temporal trends in prevalence, diagnosis age and infant mortality were examined.

RESULTS

For births 1990-2010 (allowing 6 years for complete case ascertainment by 2016), 6419 cases were identified; prevalence was 11.5 per 1000 births (95% confidence interval (CI), 11.2-11.8). Severe defects were ascertained in 2.5 per 1000 births (95% CI 2.4-2.7). Most cases were liveborn (5842, 91.0%), and 28.9% had other birth defects. Prevalence was slightly higher in Aboriginal births (prevalence ratio 1.1; 95% CI 1.0-1.2); and the infant mortality rate more than doubled (13.4% vs. 5.8%, P < 0.001). Prenatal diagnosis increased over time but, in remote areas, was significantly lower for Aboriginal versus non-Aboriginal cases (3.1% vs. 9.3%; P = 0.008). A cause was identified in 920 cases (14.3%), more often for severe defects (347, 24.4%); 63% of known causes were rare diseases. Congenital heart defects associated with fetal alcohol spectrum disorder were much more common in Aboriginal births (prevalence ratio 82; 95% CI 28-239).

CONCLUSIONS

Earlier detection of congenital heart defects and improved survival has occurred over time, although discrepancies between ethnic groups and regions warrant further investigation and strategic action.

FASD prevalence among children and youth: results from the 2019 Canadian Health Survey on Children and Youth

INTRODUCTION

The lack of national fetal alcohol spectrum disorder (FASD) prevalence estimates represents an important knowledge gap.

METHODS

Using data from the 2019 Canadian Health Survey on Children and Youth, the prevalence of FASD was examined by age, sex and Indigenous identity. Median age of diagnosis and comorbid long-term health conditions were also assessed.

RESULTS

The prevalence of FASD among Canadian children and youth living in private dwellings was 1 per 1000 (0.1%). The prevalence was significantly higher among those who identified as Indigenous and lived off reserve (1.2%).

CONCLUSION

These findings are in keeping with FASD prevalence studies that used similar passive surveillance methods. They provide a starting point to better understanding the prevalence and burden of FASD in Canada.

FASD prevalence among children and youth: results from the 2019 Canadian Health Survey on Children and Youth

INTRODUCTION

The lack of national fetal alcohol spectrum disorder (FASD) prevalence estimates represents an important knowledge gap.

METHODS

Using data from the 2019 Canadian Health Survey on Children and Youth, the prevalence of FASD was examined by age, sex and Indigenous identity. Median age of diagnosis and comorbid long-term health conditions were also assessed.

RESULTS

The prevalence of FASD among Canadian children and youth living in private dwellings was 1 per 1000 (0.1%). The prevalence was significantly higher among those who identified as Indigenous and lived off reserve (1.2%).

CONCLUSION

These findings are in keeping with FASD prevalence studies that used similar passive surveillance methods. They provide a starting point to better understanding the prevalence and burden of FASD in Canada.

Maternal psycho-social risk factors associated with maternal alcohol consumption and Fetal Alcohol Spectrum Disorder: a systematic review

PURPOSE

Fetal Alcohol Spectrum Disorder (FASD) is a preventable range of neurocognitive disorders associated with the biological mother's consumption of alcohol during pregnancy. However, on average, 45% of Australian women continue to consume alcohol during pregnancy resulting in a high rate of alcohol-exposed pregnancies and risk of FASD. This level of exposure is higher than the estimated global average of alcohol-exposed pregnancies (9.8%). This systematic literature review aims to identify demographic, health and psycho-social variables associated with alcohol consumption during pregnancy which may lead to FASD.

METHODS

Using PRISMA principles, this systematic literature review reports on psycho-social factors which increase the risk of alcohol consumption during pregnancy thereby increasing the risk of FASD.

RESULTS

Fourteen studies were accepted into this review. Studies were conducted across several countries and included a total of 386,067 cases. Seven studies were case-controlled and seven were cross-sectional design. Multiple studies identified the significance of prior mental illness, anxiety, depression, exposure to abuse and/or domestic violence and alcohol consumption behaviours of partners and family members as strong predictors of risky alcohol consumption during pregnancy and therefore associated risk of FASD.

CONCLUSION

Clinical services may be able to use the evidence-based findings from this review to improve assessment and treatment services for vulnerable women to reduce alcohol-exposed pregnancies.

Community Priority setting for Fetal Alcohol Spectrum Disorder Research in Australia

INTRODUCTION

Fetal Alcohol Spectrum Disorder (FASD) is a neurodevelopmental disorder caused by prenatal alcohol exposure (PAE). FASD research is a rapidly growing field that crosses multiple disciplines. To ensure research is relevant and meaningful for people living with FASD, their families, and the broader public there is a need to engage community members in setting priorities for research.

OBJECTIVES

Our primary objective was to formally identify the views of people living with FASD, their parents/caregivers, service providers, and the general community on the research priorities for FASD and alcohol use in pregnancy in Australia. Our secondary objective was to provide an overview of current research in the highest priority areas identified.

METHODS

The approach for this study involved two community surveys and a consensus workshop, followed by a rapid literature review. Survey responses (n = 146) were collected and grouped using qualitative thematic analysis. The themes identified were then ranked in a second survey (n = 45). The 22 highest ranked themes were considered in a workshop with 21 community members, and consensus on the top ten priority areas was sought. The priority areas were grouped into conceptually similar topics and rapid literature reviews were undertaken on each.

RESULTS

A diverse range of priorities was identified within key areas of prevention, diagnosis, and therapy. On request from participants, separate priority lists were developed by Aboriginal and non-Aboriginal participants.

CONCLUSION

There is need for a national network of researchers to take forward the research commenced by the Centre of Research Excellence, FASD Research Australia, in addressing community priorities.

KEY WORDS

Community, priorities, FASD, rapid review, Australia.

Prevalence of fetal alcohol spectrum disorder among special subpopulations: a systematic review and meta-analysis

AIM

To collate prevalence estimates of fetal alcohol spectrum disorder (FASD) among special subpopulations (defined by service use).

DESIGN

Systematic literature review and meta-analysis of original, quantitative studies published between 1 November 1973 and 1 December 2018. The PRISMAGATHER were adhered to. The review protocol [includes FASD prevalence in (a) general and (b) special populations] is available on PROSPERO (registration number: CRD42016033837). Prevalence estimates were collated for all included studies with country-, disorder- [FASD and fetal alcohol syndrome (FAS)] and population-specific random-effects meta-analyses conducted.

SETTING AND PARTICIPANTS

A number of service-defined subpopulations globally (see Findings).

MEASUREMENTS

The main outcome was the prevalence of FASD among special subpopulations. The critical appraisal of each study was conducted using the Joanna Briggs Institute tool.

FINDINGS

We identified 69 studies, comprising 6177 individuals diagnosed with FASD from 17 countries: Australia (n = 5), Brazil (n = 2), Canada (n = 15), Chile (n = 4), eastern Europe (Moldova, Romania and Ukraine; n = 1), Germany (n = 1), Israel (n = 1), Lithuania (n = 1), the Netherlands (n = 1), Poland (n = 1), Russia (n = 9), South Korea (n = 1), Spain (n = 1), Sweden (n = 1) and United States (n = 25). FAS and FASD prevalence rates were collated for the following five subpopulations: children in care, correctional, special education, specialized clinical and Aboriginal populations. The estimated prevalence of FASD in these special subpopulations was 10-40 times higher compared with the 7.7 per 1000 (95% confidence interval = 4.9-11.7) global FASD prevalence in the general population.

CONCLUSIONS

Global subpopulations of children in care, correctional, special education, specialized clinical and Aboriginal populations have a significantly higher prevalence of fetal alcohol spectrum disorder compared with the general population, which poses a substantial global health problem.

Speech-Language Pathology and the Youth Offender: Epidemiological Overview and Roadmap for Future Speech-Language Pathology Research and Scope of Practice

Purpose

This article is concerned with the growing body of international evidence indicating that adolescents in contact with the youth justice system are likely to have severely compromised oral language skills, receptively and expressively. A smaller, but persuasive, literature also points to poor literacy skills in this population. Language and literacy skills underpin academic, social, and vocational success ( C. Snow, 1983 ; P. C. Snow, 2016 ; Snowling & Hulme, 2012 ) and are central to the professional expertise of speech-language pathology as a profession ( P. C. Snow, 2016 ).

Method

In this article, I review the epidemiology of youth offending together with research evidence concerning the language and literacy skills of this population. I outline the major practice and research implications of these findings for speech-language pathology as a profession, considering the “school-to-prison pipeline” via key domains of early years' reading instruction, young people's passage through the justice system, restorative justice processes, and design and delivery of language and literacy interventions for young people on youth justice orders.

Results

Implications for speech-language pathology scope of practice and future research are outlined.

Conclusions

Speech-language pathology as a profession has a significant role to play in advocating for vulnerable young people at each point in the school-to-prison pipeline. This includes strengthening the evidence base concerning speech-language pathology language and literacy interventions and lobbying governments to fund speech-language pathology services to address the complex communication needs of this population, both on community-based and custodial orders.

Exploring service providers' perspectives on the prevention and management of fetal alcohol spectrum disorders in South Africa: a qualitative study

Background

Fetal alcohol spectrum disorder (FASD) is among the leading causes of developmental and intellectual disabilities in individuals. Although efforts are being made toward the prevention and management of FASD in South Africa, the prevalence remains high. The sustained high prevalence could be attributed to several factors, including the lack of policy for a coordinated effort to prevent, diagnose and manage FASD nationally. In this study, our aim was to explore the perspectives of service providers (health and allied professionals, teachers, social workers) on the prevention and management of FASD towards developing a guideline to inform policy.

Method

Guided by the exploratory qualitative research design, we purposively sampled relevant service providers in the field of FASD prevention and management for focus group discussions. Nine of these discussions were conducted with to eight participants per discussion session. The discussants were asked various questions on the current and required interventions and practices for the prevention and management of FASD. Following the Framework Method, data were transcribed verbatim and analysed using the thematic content analysis approach.

Results

Our findings show that aspects of the prevention and management of alcohol-related conditions are present in various policies. However, there is no clear focus on coordinated, multi-sectoral efforts for a more comprehensive approach to the prevention and management of FASD. The participants recognized the need for specific requirements on broad-based preventive awareness programs, training and support for parents and caregivers, inclusive education in mainstream schools and training of relevant professionals.

Conclusion

Comprehensive and coordinated prevention and management programs guided by a specific policy could improve the prevention and management of FASD. Policy formulation demonstrates commitment from the government, highlights the importance of the condition, and elaborates on context-specific prevention and management protocols.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6126-x) contains supplementary material, which is available to authorized users.

A systematic review of prevention interventions to reduce prenatal alcohol exposure and fetal alcohol spectrum disorder in indigenous communities

BACKGROUND

Fetal alcohol spectrum disorder (FASD) is a preventable, lifelong neurodevelopmental disorder caused by prenatal alcohol exposure. FASD negatively impacts individual Indigenous communities around the world. Although many prevention interventions have been developed and implemented, they have not been adequately evaluated. This systematic review updates the evidence for the effectiveness of FASD prevention interventions in Indigenous/Aboriginal populations internationally, and in specific populations in North America and New Zealand, and offers recommendations for future work.

METHOD

The MEDLINE, Embase, CINAHL Plus, Web of Science, PsycINFO, SocINDEX, and Informit databases were searched from inception to 22/08/2017 for all prevention and intervention papers published in peer-reviewed scientific journals, with results, targeting prenatal alcohol exposure and FASD in Indigenous populations. This review was limited to studies published in English and excluded interventions focusing on the workforce. All steps were completed independently by two reviewers with discrepancies resolved via consensus with the senior author.

RESULTS

There was significant heterogeneity in the ten included studies. Populations targeted included non-pregnant women of child-bearing age, pregnant women, school children and the general public. Study designs included one randomised controlled trial, five cohort studies with pre-post design, one cross-sectional study with different pre- and post-intervention groups, and four studies collected post-intervention data. Studies assessed changes in knowledge, and/or changes in risk for prenatal alcohol exposure including self-reported alcohol consumption, use of birth control or a combination of both. One study was conducted in Australia and nine in the US. The methodological quality of all studies was rated as 'Poor' using the systematic review assessment tools developed by The National Heart, Lung and Blood Institute. Studies were subject to substantial bias due to issues such as high loss to follow-up, lack of control groups and the reliance on self-report measures to assess the main outcome.

CONCLUSION

Overall, there is little evidence that previous interventions aiming to reduce the risk of prenatal alcohol exposure or FASD in Indigenous populations have been effective. Future intervention studies should address the cultural factors and historical context that are fundamental to successful work with Indigenous populations, and be designed, implemented and evaluated using rigorous methods. This systematic review was registered with PROSPERO, CRD42018086212.

Fetal alcohol spectrum disorder and youth justice: a prevalence study among young people sentenced to detention in Western Australia

OBJECTIVES

To estimate the prevalence of fetal alcohol spectrum disorder (FASD) among young people in youth detention in Australia. Neurodevelopmental impairments due to FASD can predispose young people to engagement with the law. Canadian studies identified FASD in 11%-23% of young people in corrective services, but there are no data for Australia.

DESIGN

Multidisciplinary assessment of all young people aged 10-17 years 11 months and sentenced to detention in the only youth detention centre in Western Australia, from May 2015 to December 2016. FASD was diagnosed according to the Australian Guide to the Diagnosis of FASD.

PARTICIPANTS

99 young people completed a full assessment (88% of those consented; 60% of the 166 approached to participate); 93% were male and 74% were Aboriginal.

FINDINGS

88 young people (89%) had at least one domain of severe neurodevelopmental impairment, and 36 were diagnosed with FASD, a prevalence of 36% (95% CI 27% to 46%).

CONCLUSIONS

This study, in a representative sample of young people in detention in Western Australia, has documented a high prevalence of FASD and severe neurodevelopmental impairment, the majority of which had not been previously identified. These findings highlight the vulnerability of young people, particularly Aboriginal youth, within the justice system and their significant need for improved diagnosis to identify their strengths and difficulties, and to guide and improve their rehabilitation.

Study protocol for screening and diagnosis of fetal alcohol spectrum disorders (FASD) among young people sentenced to detention in Western Australia

INTRODUCTION

Prenatal alcohol exposure can cause lifelong disability, including physical, cognitive and behavioural deficits, known as fetal alcohol spectrum disorders (FASD). Among individuals with FASD, engagement with justice services is common. Little is known about the prevalence of FASD among young people engaged with the Australian justice system. This study aims to establish FASD prevalence among sentenced young people in detention in Western Australia (WA), and use the findings to develop a screening tool for use among young people entering detention. Translation of these results will guide the management and support of young people in detention and will have significant implications on the lives of young people with FASD and the future of Australian youth justice services.

METHODS AND ANALYSIS

Any sentenced young person in WA aged 10-17 years 11 months is eligible to participate. Young people are assessed for FASD by a multidisciplinary team. Standardised assessment tools refined for the Australian context are used, acknowledging the language and social complexities involved. Australian diagnostic guidelines for FASD will be applied. Information is obtained from young people, responsible adults, teachers and custodial officers. Individualised results and management plans for each young person are communicated to the young person and responsible adult. Prevalence of FASD will be reported and multivariate methods used to identify variables most predictive of FASD and to optimise the predictive value of screening.

ETHICS AND DISSEMINATION

Approvals have been granted by the WA Aboriginal Health Ethics Committee, University of WA Human Research Ethics Committee, Department of Corrective Services, and Department for Child Protection and Family Support. Anonymised findings will be disseminated through peer-reviewed manuscripts, presentations and the media. Extensive consultation with stakeholders (including government agencies, detention centre staff, community service providers, the young people and their families or carers) will be ongoing until findings are disseminated and translated.