Factors to be considered as part of a holistic assessment for fetal alcohol spectrum disorder: A scoping review

We undertook a scoping review to identify the factors outside of current fetal alcohol spectrum disorder (FASD) diagnostic criteria to be considered as part of a holistic assessment process. This included physical, social, cultural, mental health and wellbeing factors to inform targeted recommendations and supports to improve outcomes for individuals with FASD. Evidence from this review will be used to inform the revision of the Australian Guide to the Diagnosis of FASD. Six electronic databases were searched. Studies were eligible if they included factors outside of the diagnostic criteria that cover dysmorphology, growth restriction, neurodevelopmental impairments. Data charting and content analysis were performed to synthesize the results. One hundred twenty-one studies were included that spanned 12 key areas These included physical health, sleep, adverse postnatal experiences, substance use/other risk-taking behaviors, contact with the criminal justice system, mental health, First Nations cultural considerations, transition to adult roles, involvement with the out-of-home care system, feeding and eating, strengths/interests/external resources and incontinence. Areas to be considered as part of a holistic assessment and diagnostic process spanned individual, family, and system level factors. Results provide guidance for clinicians on the wide range of factors that could influence long-term health, development, and wellbeing for individuals with prenatal alcohol exposure and FASD. In practice, this guidance can be used to inform an individualized assessment process to facilitate tailored recommendations and supports to best meet the complex needs of individuals living with FASD and their families.

Lived experiences of the diagnostic assessment process for fetal alcohol spectrum disorder: A systematic review of qualitative evidence

Early assessment and diagnosis of FASD are crucial in providing therapeutic interventions that aim to enhance meaningful participation and quality of life for individuals and their families, while reducing psychosocial difficulties that may arise during adolescence and adulthood. Individuals with lived experience of FASD have expertise based on their own lives and family needs. Their insights into the assessment and diagnostic process are valuable for improving service delivery and informing the provision of meaningful, person- and family-centered care. To date, reviews have focused broadly on the experiences of living with FASD. The aim of this systematic review is to synthesize qualitative evidence on the lived experiences of the diagnostic assessment process for FASD. Six electronic databases, including PubMed, the Cochrane Library, CINAH, EMBASE, PsycINFO, and Web of Science Core Collection were searched from inception until February 2021, and updated in December 2022. A manual search of reference lists of included studies identified additional studies for inclusion. The quality of included studies was assessed using the Critical Appraisal Skills Program Checklist for Qualitative Studies. Data from included studies were synthesized using a thematic analysis approach. GRADE-CERQual was used to assess confidence in the review findings. Ten studies met the selection criteria for inclusion in the review. Thematic analysis identified 10 first-level themes relating to four over-arching topics: (1) pre-assessment concerns and challenges, (2) the diagnostic assessment process, (3) receipt of the diagnosis, and (4) post-assessment adaptations and needs. GRADE-CERQual confidence ratings for each of the review themes were moderate to high. The findings from this review have implications for referral pathways, client-centered assessment processes, and post-diagnostic recommendations and support.

Collaborative team approaches to supporting inclusion of children with disability in mainstream schools: A co-design study

BACKGROUND

Collaborative consultation involving educational staff, allied health professionals and parents working towards goals for children with disability is considered best practice in inclusive education. However, challenges can hinder effective collaboration, thereby potentially limiting child outcomes.

AIMS

The study aims were to (a) explore the experiences of teachers, teacher assistants, allied health professionals, and parents engaging in collaborative teamwork to support inclusion of children with disability in mainstream primary schools, and (b) identify key factors influencing effective teamwork and the design of support strategies.

METHODS AND PROCEDURES

A co-design research method emulated collaborative consultation and authentic stakeholder teamwork. Data were from a series of six co-design workshops (15 h); discussions were audio-recorded and transcribed verbatim. An interpretive descriptive method of thematic analysis resulted in four key themes.

OUTCOMES AND RESULTS

Critical factors that influenced collaborative teamwork were access to diagnosis and funding, mechanisms for team communications, practical ways of working together, and shared understandings of inclusion.

CONCLUSIONS AND IMPLICATIONS

Stakeholder teams require effective communication mechanisms and practical ways of working together within and outside of classrooms. Shared understandings of inclusion provide a foundation for collaboration, requiring access to professional development to ensure teamwork is informed by best inclusive education practice.

The Alcohol Industry and Social Responsibility: Links to FASD

Fetal Alcohol Spectrum Disorder is directly linked to the consumption of alcohol during pregnancy. Prevention programs have been targeted at women of childbearing age and vulnerable populations. The beverage alcohol industry (manufacture, marketing, distribution, and retail) is often seen as playing a role in prevention strategies such as health warning labels. In this paper we explore the nature of the relationship between the industry and prevention programming. We consider the place of alcohol in society; the prevalence, social and economic costs of FASD; the ethical notion of alcohol-related harm and then move onto the question of public health partnerships with the industry including the potential conflicts of interests and ethical challenges in such partnerships.

How Personal Perspectives Shape Health Professionals' Perceptions of Fetal Alcohol Spectrum Disorder and Risk

This article examines how health, allied health and social service professionals' personal perspectives about alcohol and the risks associated with alcohol consumption become non-clinical factors that may influence their professional practice responses in relation to fetal alcohol spectrum disorder (FASD). It presents findings derived from a qualitative, interview-based study of professionals from a range of health, allied health and social service professions in New Zealand. The data derived from these interviews revealed four frames of reference that practitioners use when thinking about alcohol and risk: reflection on personal experience; experiences of friends, relatives and colleagues; social constructions of alcohol use and misuse; and comparisons to other types of drug use. The article concludes that these non-clinical factors are important considerations in professional decision making about FASD.

Responding to FASD: what social and community service professionals do in the absence of diagnostic services and practice standards

Purpose

The purpose of this paper is to ascertain the experiences and practices of social and community service professionals working with Fetal Alcohol Spectrum Disorder (FASD) or suspected FASD in New Zealand.

Design/methodology/approach

The research examined professionals’ empirical experience of working with FASD or suspected FASD. In total, 21 participants working in practice settings relevant to dual diagnosis were interviewed, with each interview being of 1–2 h duration. The interview data were transcribed and coded using the constant-comparative method in order to derive themes.

Findings

Participants identified a number of barriers to understanding or working with FASD: the limited knowledge of FASD and the absence of FASD from training contexts, difficulty obtaining institutional support and the challenge of working without a diagnosis. Participants also articulated a range of strategies for approaching FASD within the identified barriers of their practice contexts, specifically: working with alternative diagnoses, focussing on adjusting expectations, adopting a strengths-based approach, actively advocating for clients when working with other sectors and systems and focussing on prevention education.

Originality/value

This research expands the knowledge base for social and community service practice in contexts where FASD maybe a factor contributing to poor health and well-being outcomes for clients. It clarifies the challenges that professionals face when encountering FASD or suspected FASD in their work, reveals key gaps in individual and systemic knowledge about FASD and provides new insight into what professionals do to address these challenges. It also adds to the body of research concerning FASD in the Australasian context more broadly.

Speech-language pathology intervention in a youth justice setting: Benefits perceived by staff extend beyond communication

PURPOSE

Young people in youth justice (YJ) settings face high-risk for unidentified language disorder, however, speech-language pathology (SLP) services are not routinely offered in such settings. The aim of this study was to explore and describe the perceptions and experiences of YJ staff in a custodial centre of the utility of having a speech-language pathologist working with young offenders.

METHOD

Following a SLP intervention trial, two staff focus groups were conducted by an independent SLP. Interview probes were developed through review of the literature and consultation with the practitioner who conducted the clinical intervention. Focus groups were digitally recorded for thematic analysis, which was carried out by the three authors independently.

RESULT

YJ staff expressed consistently positive views about the SLP intervention trial in their centre. Staff indicated that they learnt a great deal about the complexity of communication difficulties in this population, and that this information informed and guided their own practices. They expressed surprise at the engagement of young people in the SLP service, and supported its embedding in the YJ setting.

CONCLUSION

YJ staff endorsed the value of a SLP service in a custodial setting. Further research should focus on refining measurement of this service and its impact.

Tree nut allergies: Allergen homology, cross-reactivity, and implications for therapy

Tree nut allergy is a potentially life-threatening disease that is increasing in prevalence, now affecting 1% of the general population in the United States. While other food allergies often resolve spontaneously, tree nut allergies are outgrown in less than 10% of cases. Due to the likelihood of cross-sensitization to multiple tree nut allergens, the current treatment guideline is strict avoidance of all nuts once one tree nut allergy has been diagnosed. For example, walnut and pecan are highly cross-reactive, along with cashew and pistachio, but the extent of clinical, IgE-mediated cross-reactivity among other tree nuts remains unclear, therefore making avoidance of all tree nuts a safe approach. There have been recent advances in immunotherapy for food allergies. For instance, there are investigational immunotherapies for milk, egg and peanut allergies, specifically oral immunotherapy, sublingual immunotherapy and epicutaneous immunotherapy. However, there are no large randomized controlled clinical trials for tree nut allergies. Even though there has been less research into tree nut allergy immunotherapies, the evidence of T-cell cross-reactivity among tree nuts exists in animal models and in T cells from allergic patients indicates that immunotherapeutic interventions may be possible. Here, we review the literature regarding epidemiology, allergen homology and cross-reactivity among tree nuts, and explore how current findings can be employed for effective therapy.

Body-image perception in pre- and postadolescent females

The purpose of this study was to examine both perceived and ideal body-image to establish if the process of adolescence was a contributory factor. A distorting mirror and silhouette pictures were used to examine the image in two groups of 59 pre- and 41 postadolescent girls. The girls' perception of themselves was reasonably accurate yet both groups had a significantly slimmer mean ideal image, irrespective of adolescent status. The differences between the two groups were nonsignificant whether using the distorting mirror or the pictures. The only difference to be observed was when using a body-satisfaction scale. The postadolescents were significantly less satisfied about their nonhead body parts. Scores from the mirror and the pictures question the assumption that body-image dissatisfaction is a postadolescent phenomenon. This should be a cause for concern as eating disorders, which appear to be linked to body-image, are being observed in younger children. The comparability between scores for the pictures and the distorting mirror opens the possibility of home-based therapy in the treatment of perceptual and eating disorders.

Fourier transform infrared difference spectroscopy of bacteriorhodopsin and its photoproducts

Fourier transform infrared difference spectroscopy has been used to obtain the vibrational modes in the chromophore and apoprotein that change in intensity or position between light-adapted bacteriorhodopsin and the K and M intermediates in its photocycle and between dark-adapted and light-adapted bacteriorhodopsin. Our infrared measurements provide independent verification of resonance Raman results that in light-adapted bacteriorhodopsin the protein-chromophore linkage is a protonated Schiff base and in the M state the Schiff base is unprotonated. Although we cannot unambiguously identify the Schiff base stretching frequency in the K state, the most likely interpretation of deuterium shifts of the chromophore hydrogen out-of-plane vibrations is that the Schiff base in K is protonated. The intensity of the hydrogen out-of-plane vibrations in the K state compared with the intensities of those in light-adapted and dark-adapted bacteriorhodopsin shows that the conformation of the chromophore in K is considerably distorted. In addition, we find evidence that the conformation of the protein changes during the photocycle.