AccessAbility Day 2: Article Summary- Intervention recommendations and subsequent access to services following clinical assessment for fetal alcohol spectrum disorders

Background
Children with FASD and prenatal alcohol exposure (PAE, without a formal FASD diagnosis) require various interventions to address the challenges they face on a daily basis. This study by Pei et al., 2017, looks at differences in intervention recommendations for children with FASD and PAE (no FASD diagnosis), and access to these interventions. The researchers investigated specifically, which categories of interventions are most likely to be accessed and how accessibility relates to the recommendations given. They also looked at how the age of assessment for PAE, as well as adverse events/exposures prenatally or postnatally, might affect intervention recommendations.

 Total group recommendations

  • Based on 279 children included in the study, the average number of recommendations per child was 8.82.
  • The order of most common recommendations to least common:
    • Educational
    • Medical
    • Anticipatory guidance (i.e., increasing awareness and/or decreasing risk of potential future problems)
    • Accommodations
    • Family support
  • Less than half of families received recommendations in the following categories:
    • Mental health
    • Developmental therapy
    • Social services/child welfare
    • Community/social/leisure programs
    • Safety
    • Reassessment

 Comparing recommendations across age groups and pre/postnatal scores

  • Fewer recommendations were made across increasing age groups for categories:
    • Family support
    • Developmental therapy
  • More recommendations were made across increasing age groups for:
    • Mental health
  • The severity of adverse experiences and exposure pre/postnatally was not significantly linked with recommendations in each category
    • There was, however, increased likelihood of mental health recommendations for individuals with higher postnatal adversity

 Comparing recommendations for FASD and PAE groups

  • Children with FASD received significantly more recommendations than those with PAE (and no FASD diagnosis) in the categories:
    • Education
    • Anticipatory guidance
    • Family support
    • Safety
  • Those in the PAE group (and no FASD diagnosis) received more recommendations in the categories:
    • Mental health
    • Reassessment

Follow up: Access to interventions

  • 72% of all recommended interventions were accessed
  • Individualized program plan (IPP)/modified school program was accessed 100% of the time
  • At least half accessed:
    • Developmental therapy
    • Medication/psychiatry
    • Counseling for the child
    • Support for the parent
    • Parent advocacy or education
  • Without a recommendation, the most commonly accessed interventions were:
    • Parent advocacy/education
    • Access to interventions in the absence of clinical recommendation may indicate that these interventions are more easily accessible, or that the family deems them more important.
  • No families accessed behavioral therapy without a recommendation

Implications for clinical practice and future research
The broad spectrum and frequency of recommendations show how diverse the needs are of children with PAE (without a diagnosis), and children with FASD. It is crucial that recommendations given to children with FASD/PAE are available in their community, and that they are likely to be implemented. The findings from this study can help advocate for services and appropriate interventions for individuals with FASD/PAE and their families.

Take-home message
More recommendations were made in the categories of developmental therapy and family support for younger children, indicating the importance of early interventions for individuals with FASD/PAE. Even though children with diagnosed FASD received more recommendations than those with PAE (but no FASD diagnosis), those in the PAE group still received many recommendations in all categories. Children with FASD and PAE have extensive needs and should receive recommendations tailored to their individual needs, as opposed to broadly recommending interventions based on diagnosis alone.

Authors: Jacqueline Pei, Lauren Baugh, Gail Andrew, Carmen Rasmussen

Journal: Research in Developmental Disabilities

 

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