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04/10/2019
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Multidisciplinary Assessment & Interventions for FASD in Scotland
Dr Jennifer Shields, Principal Clinical Psychologist
Scottish Government funded Fetal Alcohol Advisory & Support Team
Introducing the Scottish SIGN Guideline
• Published in January 2019 based on Canadian Guidelines
• Advocates assessment of brain areas using standardised assessment (where possible) including mental health & emotion regulation
• Scotland have chosen to implement this guideline in mainstream services e.g. CAMHS & Paediatrics rather than specialist clinics.
• Our team piloted the first Scottish FASD pathway & now support the implementation of FASD assessment nationally via training, consultation & research – see Twitter: @fasdadvisoryaaa
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Pilot Project Summary Report (now online) McGruer & Shields (2018) www.nhsaaa.net- outlines main findings (free access)
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A brief overview of assessment of FASD in Ayrshire
FASD is explored largely within child & yp
neurodevelopmental pathways
We recommend children are referred with
neurodevelopmental queries rather than for
FASD specifically
Only if a +ve alcohol history or full facial features should
FASD be considered.
Potential Assessment Tools
Behavioural Assessment of Dysexecutive Syndrome –children (C‐BADS)**
School Reports / Wechsler Individual Achievement Test
Movement ABC & Beery Visual Motor Integration + Sensory Profile Measure
Paediatric Assessment & Genetics
Adaptive Behaviour Assessment Schedule (ABAS) + Theory of Mind Subtests
Test of Everyday Attention in Children (TEA‐Ch 2)
Wechsler Intelligence Scale for Children (WISC) / WIPPSI
Clinical Evaluation of Language Fundamentals (CELF)
Children’s Memory Scale / RivermeadBehavioural Memory TestTwitter @jenspsy
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Mental Health Assessment(a necessary first step!)
31.8%“I think about suicide,
but wouldn’t do it”
4.5%“I want to kill myself
Child’s Depression Inventory (CDI) indicated this: - >
Key Learning:
Children with FASD may not appear as or describe being depressed / anxious & may say they are ‘okay’- this cannot be taken at face value given the responses seen on the CDI.
(McGruer & Shields, 2018)
1st brain area assessed: Speech and Language
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Core Receptive Expressive Content Memory Structure
CELF4
CELF PS
This graph depicts average scores of our pilot data – many children had significant comprehension & expressive issues & struggle more as they
get older. These issues can be well masked by sociability....
Twitter @jenspsy
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Cognitive Assessment
Pilot children acquired reasonable scores on a cognitive assessment – the key point ‐ don’t stop here!
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FSIQ VCI PRI WMI PS
Overall 1.5 SD+ below
7.7% FSIQ <50
7.7% Learning Disability Diagnosis
Twitter @jenspsy
(McGruer & Shields, 2018)
Attention
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Teach 2 SAI Teach 2 Sus Teach 2 EAI
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TEA‐Ch2 Connors 3 Parent
Children can often have other reasons to ‘appear’ inattentive or restless e.g. Motor issues, sensory issues, not understanding in class etc ....
Sustained attention was a relative strength
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Executive FunctionBehavioural Assessment of Dysexecutive Syndrome
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GEC BRI ERI CRI
BRIEF‐2 Parent
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Overall Scaled Score
Male
Female
Overall
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GEC BRI ERI CRI
Male
Female
Overall
Twitter @jenspsy
This is an area of significant difficulty in FASD.
Our BRIEF screening QA correlated well with the Behavioural Assessment of
Dysexecutive Syndrome (BADS – 35 min) .
Adaptive Behaviour Assessment System (ABAS)
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GAC Concept Practical Social
Parent
Teacher
Again – this is an area of significant difficulty – an ABAS can be included in most assessments, whether this takes place in CAMHS or Paediatrics & often scores are lower than a cognitive assessment would suggest. In school appear more able
ABAS‐3
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What you see is NOT always what you get: (an example profile)
Communicating the findings
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Key Learning Points...
• In Scotland over 300 clinicians are now trained in FASD assessment.
• Cognitive assessment is insufficient for affected individuals.
• Two thirds of our pilot children had a previous diagnosis of ADHD. Bear in mind that inattention & overactivity can be due to executive function, motor, sensory or language issues.
• Scottish clinicians may use the descriptor of “FASD with / without SFF alongside a DSM V – diagnosis of Specified Neurodevelopmental Disorder (pre‐natal alcohol exposed)
• All of these issues impact day to day function at school and at home and can be incorrectly formulated as behavioural / emotional difficulties. Understandingstrengths and difficulties is often an intervention in itself. Strategies & supports should always be guided by a profile of strengths and difficulties.
All materials within this presentation and available todaybelong to NHS Ayrshire and Arran. If you would like to
reproduce any of this material for educational purposes,please contact us for permission.
Sincere apologies I couldn’t be here today
I’ll be following / tweeting
@jenspsy
@fasdadvisoryaaa
Huge thanks to Alex for
presenting my slides
Thank you
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