Fetal Alcohol Spectrum Disorder – Management

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After taking an extensive history and performing multiple clinical examinations in consultation with allied health staff, you come to the conclusion that Callum has a diagnosis of foetal alcohol spectrum disorder. His mother is mortified about the situation and isn’t sure what this will mean for Callum (both now and in the future) as well as the family.

You can read about the background of FASD here. If you want to know how the diagnosis is made then you should read Mary’s earlier post.

What is the role of the paediatrician in the management of FASD?

  1. Early identification
  2. Education and anticipatory guidance for families
    • Helping parents to understand the neurobehavioural difficulties of FASD
    • Helping parents develop appropriate expectations
    • Preparing parents for age-related changes in behaviour/risks
  3. Providing family support
    • Reduce stigma/shame
    • Acknowledge the challenges of having a child who has FASD
    • Provide resources
    • Assess the risk for child abuse and neglect
  4. Medical management
    • Linking families with community services
    • Monitor growth/nutrition and medical conditions
    • Identify co-existing mental health conditions
    • Plan for transition

What are the different levels of prevention to consider in the management FASD?

  1. Primary prevention – the elimination of the root cause of a problem by broad-based efforts to promote the health and well-being of a community (ie. To have no foetuses exposed to alcohol therefore eliminating FASD before it ever occurs)
  2. Secondary prevention – to reduce the duration and severity of maternal drinking by identification of the person at risk
  3. Tertiary prevention – reducing the complications, impairments, and disabilities caused by FAS, and includes activities that prevent recurrence of the condition in subsequent children.

One must consider all levels of prevention as paediatric patients can and do get pregnant!

What conditions should be ‘screened’ for when a diagnosis of FASD is made?

    • Hearing impairment (audiology)
    • Vision impairment (optometrist)
    • Cardiac diagnoses (echo)
    • Renal abnormalities (USS kidneys, ureters, bladder)
    • Learning and behavioural difficulties

What are families eligible for in Australia?

    • Carers payment/allowance
    • NDIS support
    • Chronic disease management plan – done through the GP
    • Local support groups

What about medication?

Medications are not first line in FASD although may be used in conjunction with behavioural and environemental/family interventions to treat FASD co-morbidities including:

    • Attention Deficit Hyperactivity Disorder
    • Depression
    • Anxiety
    • Aggression
    • Sleep disturbances

It should be remembered that some of the symptoms of FASD may mimic conditions such as ADHD therefore if a trial of medication is not found to be beneficial, it should be discontinued.

General recommendations for every family

These should be made to every family to improve behaviour management and promote development of social and cognitive skills. They do not need to be made “all at once” as the family may find this overwhelming however should be included in your ongoing consultants to help reduce the complications of FASD and improve family cohesion.

 

Secure attachment and positive relationships can be promoted by:

  • Providing “special time” with the child every day (consistent, undistracted quality time)
  • Assuring the child that this home is safe and permanent

 

Problem behaviours may be reduced by:

  • Increasing the predictability and structure of the home and school environment
  • Using visual prompts and sequences to simplify instructions, and reinforce and remind children how to perform activities of daily living
  • Developing behaviour plans built on positive reinforcement and healthy discipline strategies
  • Simplifying the environment (eg. avoiding multistep commands, reducing distractions)

 

Families can work to enhance development and cognitive functioning by:

  • Increasing functional language skills in daily activities (eg. through reading, telling stories, and pretend play)
  • Promoting self-care activities and adaptive skills (eg. reinforcing attempts and successes of desired behaviours, limiting the number of choices and decisions, modelling desired behaviours)
  • Enhancing basic mathematic skills (eg. teaching about volume, weight, and length through play, monetary values when shopping)
  • Developing social skills through play dates and the use of social stories
  • Reinforcing appropriate social boundaries (eg. reading social cues, rehearsing social scenarios)
  • Developing executive functioning skills (eg. using visual schedules, highlighting or colour coding academic lessons, labelling tasks or homework for the child, sequencing steps in a task, developing checklists)

 

Fact sheets for families:

http://www.nofasd.org.au/resources/fact-sheets

https://www.cdc.gov/ncbddd/fasd/documents/fasd_english.pdf

 

 

 

References

The Working Group for FAS. 2003, August. Prevention of Foetal Alcohol Syndrome (FAS). Canadian Academy of Child and Adolescent Psychiatry. 12(3): 87-91. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582740/

National Organization for Foetal Alcohol Spectrum Disorders. Australian Government. Department of Health. 2017. Available from: http://www.nofasd.org.au

Weitzman C, Rojmahamongkol P. 2017 July.  “Fetal alcohol spectrum disorder: Management and prognosis”. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA

Australian Medical Association. 2016 August 24. “Fetal Alcohol Spectrum Disorder (FASD) – 2016.” Barton, ACT. Link: https://ama.com.au/position-statement/fetal-alcohol-spectrum-disorder-fasd-2016

McDougall S, Mclean S. 2014. “Foetal alcohol spectrum disorders: current issues in awareness, prevention and intervention.” Child Family Community Australia. Available at: https://aifs.gov.au/cfca/sites/default/files/publication-documents/cfca-paper29-fasd.pdf

 

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About 

Mary is an advanced trainee in General Paediatrics/Community and Developmental Paediatrics. Has called Townsville home for the last decade. Outside of work, she enjoys eating and Crossfit (one of ‘those people’!)

Author: Mary Hardimon

Mary is an advanced trainee in General Paediatrics/Community and Developmental Paediatrics. Has called Townsville home for the last decade. Outside of work, she enjoys eating and Crossfit (one of ‘those people’!)