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Scottish Government funded Fetal Alcohol Advisory & Support Team

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

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Scottish Government funded Fetal Alcohol Advisory & Support Team

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  1. Multidisciplinary Assessment & Interventions for FASD in ScotlandDr Jennifer Shields, Principal Clinical Psychologist Scottish Government funded Fetal Alcohol Advisory & Support Team

  2. 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

  3. Pilot Project Summary Report (now online) McGruer & Shields (2018) www.nhsaaa.net - outlines main findings (free access)

  4. 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.

  5. Potential Assessment Tools Adaptive Behaviour Assessment Schedule (ABAS) + Theory of Mind Subtests Test of Everyday Attention in Children (TEA-Ch 2) Paediatric Assessment & Genetics Wechsler Intelligence Scale for Children (WISC) / WIPPSI School Reports / Wechsler Individual Achievement Test Clinical Evaluation of Language Fundamentals (CELF) Movement ABC & Beery Visual Motor Integration + Sensory Profile Measure Children’s Memory Scale / Rivermead Behavioural Memory Test Behavioural Assessment of Dysexecutive Syndrome – children (C-BADS)** Twitter @jenspsy

  6. Mental Health Assessment (a necessary first step!) (McGruer & Shields, 2018) 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.

  7. 1st brain area assessed: Speech and Language 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

  8. Cognitive Assessment (McGruer & Shields, 2018) Overall 1.5 SD+ below Pilot children acquired reasonable scores on a cognitive assessment – the key point - don’t stop here! 7.7% FSIQ <50 7.7% Learning Disability Diagnosis Twitter @jenspsy

  9. Attention Sustained attention was a relative strength Connors 3 Parent TEA-Ch2 Children can often have other reasons to ‘appear’ inattentive or restless e.g. Motor issues, sensory issues, not understanding in class etc ....

  10. Executive Function Behavioural Assessment of Dysexecutive Syndrome BRIEF-2 Parent 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) . Twitter @jenspsy

  11. Adaptive Behaviour Assessment System (ABAS) ABAS-3 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

  12. What you see is NOT always what you get: (an example profile)

  13. Communicating the findings

  14. 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.Understanding strengths and difficulties is often an intervention in itself. Strategies & supports should always be guided by a profile of strengths and difficulties.

  15. Thank you Sincere apologies I couldn’t be here today I’ll be following / tweeting  @jenspsy @fasdadvisoryaaa Huge thanks to Alex for presenting my slides All materials within this presentation and available todaybelong to NHS Ayrshire and Arran. If you would like toreproduce any of this material for educational purposes,please contact us for permission.

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