DIAGNOSING FASD IN ADULTS: THE DEVELOPMENT AND OPERATION OF AN ADULT FASD CLINIC IN ONTARIO, CANADA
Main Article Content
Keywords
Fetal alcohol spectrum disorder, FASD assessment, adult, diagnosis
Abstract
This paper describes the development and operation of an interdisciplinary Fetal Alcohol Spectrum Disorders (FASD) diagnostic clinic focussing specifically on adults. The clinic is embedded within a community- based interdisciplinary health agency specializing in intellectual and developmental disabilities . A review of the clinic’s assessment process is presented describing the steps from intake to feedback and intervention. To date, the clinic has received 93 referrals and given 41 alcohol -related diagnoses including 10 completed using videoconferencing technology. Issues unique to adult diagnosis are discussed as well as some of the challenges, including high rates of cancellations/no -shows for appointments, obtaining background and historical information, establishing maternal alcohol history, working collaborativ ely with other support sectors such as children’s protective services and the justice system, and finding appropriate follow -up and intervention services in the community. Recommendations for future work to support adults with FASD and their families are presented.
References
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17. Temple VK, Valiquette S, Drummond C, Jozsvai E. A comparison of intellectual assessments over video conferencing and in-person for individuals with ID: preliminary data. Journal of Intellectual Disability Research 2010;54(6):573- 577.
18. Clark E, Lutke J, Minnes P, Ouellette -Kuntz H. Secondary disabilities among adults with fetal alcohol spectrum disorder in British Columbia. Journal of FAS International 2004;2(13):1- 12.
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20. Denys K, Rasmussen C, Henneveld D. The effectiveness of a community -based intervention for parents with FASD. Community Mental Health Journal 2011;47:209- 219.
21. Grant T, Huggins J, Connor P, Pedersen J, Whitney N, Streissguth A. A pilot community intervention for young women with fetal alcohol spectrum disorders. Community Mental Health 2004; 40: 499- 511.
22. Nash K. Improving executive functioning in children with fetal alcohol spectrum disorder using the Alert Program for Self Regulation. Doctoral dissertation, University of Toronto (2012) https://tspace.library.utoronto.ca/bitstream/1807/ 34820/1/ Nash_Kelly_J_201211_P hD_Thesis.pdf
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2. Chudley A, Conry J, Cook J, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Canadian Medical Association Journal 2005;172(5): S1- S21.
3. Hoyme HE, May PA, Kalberg WO, et al. A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: Clarification of the 1996 Institute of Medicine criteria. Pediatrics 2005;115:39– 47.
4. Chudley A, Kilgour A, Cranston M, Edwards M. Challenges of diagnosis in fetal alcohol syndrome and fetal alcohol spectrum disorder in the adult. American Journal of Medical Genetics 2007;45:C261– 272.
5. Spohr H, Willms J, Steinhausen H. Fetal alcohol spectrum disorders in young adulthood. The Journal of Pediatrics 2007;150:175- 9.
6. Streissguth A. Offspring effects of prenatal alcohol exposure from birth to 25 years: The Seattle Prospective Longitudinal study. Journal of Clinical Psychology in Medical Settings 2007;14:81– 101.
7. Temple VK, Shewfelt L, Tao L, Casati J, Klevnick L. Comparing daily living skills in adults with fetal alcohol spectrum disorders to an IQ matched clinical sample. Journal of Population Therapeutics Clinical Pharmacology 2013;18(2):e397- 402.
8. Barr H, Books tein F, O’Malley K, Connor P, Huggins J, Streissguth A. Binge drinking during pregnancy as a predictor of psychiatric disorders on the structured clinical interview for DSM -IV in young adult offspring. American Journal of Psychiatry 2006;163(6):1061– 1065.
9. Badry D. Inventory of literature on the assessment and diagnosis of FASD among adults: A national and international systematic review (2010). http://www.phac -aspc.gc.ca/fasd - etcaf/index -eng.php .
10. Streissguth A, Aase J, Clarren S, Randels S, LaDue R, Smith D. Fetal alcohol syndrome in adolescents and adults. Journal of American Medical Association 1991;265:1961- 1967.
11. Institute of Health Economics. Consensus statement on legal issues in FASD. Edmonton: IHE, 2013.
12. McFarlane A. Fetal Alcohol spectrum disorder in adults: Diagnosis and assessment by a interdisciplinary team in a rural area. Canadian Journal of Rural Medicine 2011;16(1):25- 30.
13. Baer JS, Sampson PD, Barr HM, Connor PD, Streissguth AP. A 21 -year longitudinal analysis of the effects of prenatal alcohol exposure on young adult drinking. Archives of General Psychiatry 2003;60:377 -385.
14. Streissguth A, Barr H, Kogan J, Bookstein F. Primary and secondary disabilities in fetal alcohol syndrome. In Streissguth A, Karter J, eds. The Challenges of Fetal Alcohol Syndrome. Seattle: University of Washington Press, 1997:25- 39.
15. Astley SJ. Diagnostic guide for fetal alcohol spectrum disorders: The 4 -digit diagnostic code, Third Edition. University of Washington Publication Services; 2004.
16. Rasmussen C, Andrew G, Zwaigenbaum L, Tough S. Neurobehavioural outcomes of children with fetal alcohol spectrum disorders: a Canadian perspective. Paediatric Child Health 2008;13(3):185- 191.
17. Temple VK, Valiquette S, Drummond C, Jozsvai E. A comparison of intellectual assessments over video conferencing and in-person for individuals with ID: preliminary data. Journal of Intellectual Disability Research 2010;54(6):573- 577.
18. Clark E, Lutke J, Minnes P, Ouellette -Kuntz H. Secondary disabilities among adults with fetal alcohol spectrum disorder in British Columbia. Journal of FAS International 2004;2(13):1- 12.
19. Wheeler JA, Kenney KA, Temple VK. Fetal Alcohol Spectrum Disorder: A literature review of services and intervention s for adults. Journal on Developmental Disabilities 2013;19(3):62- 75.
20. Denys K, Rasmussen C, Henneveld D. The effectiveness of a community -based intervention for parents with FASD. Community Mental Health Journal 2011;47:209- 219.
21. Grant T, Huggins J, Connor P, Pedersen J, Whitney N, Streissguth A. A pilot community intervention for young women with fetal alcohol spectrum disorders. Community Mental Health 2004; 40: 499- 511.
22. Nash K. Improving executive functioning in children with fetal alcohol spectrum disorder using the Alert Program for Self Regulation. Doctoral dissertation, University of Toronto (2012) https://tspace.library.utoronto.ca/bitstream/1807/ 34820/1/ Nash_Kelly_J_201211_P hD_Thesis.pdf
23. Canada FASD Research Network. Diagnostic Clinics. (2014) http://www.canfasd.ca/research - library/diagnostics -clinics/
24. FASD -Ontario Network of Expertise Diagnostic Services. (2014) http://www.fasdontario.ca/cms/service - areas/diagnostic/diagnostic -services/
25. Legislative Assembly of Ontario Select Committee on Developmental Service s. Inclusion and opportunity: A new path for Developmental Services in Ontario. (2014) http://www.ontla.on.ca/committee - proceedings/committ ee- reports/files_pdf/SCDSFinalReportEnglish.pdf .
26. Beery KE, Buktenica NA, Beery, NA. The Beery -Buktenica Developmental Test of Visual-Motor Integration, Sixth Edition. Pearson; 2010.
27. Wechsler, D. Wechsler Adult Intelligence Scale, Fourth Edition. Psychological Corporation; 2008.
28. Semel E, Wiig EH, Secord WA. Clinical Evaluation of Language Fundamentals, Fifth Edition. Pearson; 2013.
29. Martin NA, Brownell R. Test of Auditory Processing Skills, Third edition. WPS; 2005.
30. Dunn LM, Dunn DM. Peabody Vocabulary Test , Fourth Edition. Pearson; 2007.
31. Williams KT. Expressive Vocabulary Test, Second Edition. Pearson; 2007.
32. Wilkinson GS, Robertson GJ. Wide Range Achievement Test, Fourth Edition. Psychological Assessment Resources; 2007.
33. Wechsler D. Wechsler Memory Scale, Third Edition -abbreviated; Psychological Corporation; 2003.
34. Wilson BA, Emslie H, Evans JJ, Alderman N, Burgess PW. Behavioral Assessment of the Dysexecutive Syndrome. Pearson; 1996.
35. Gioia GA, Isquith PK, Guy SC, Kenworthy L. Behavior Rating Inventory of E xecutive Function. Psychological Assessment Resources; 2000.
36. Harrison P, Oakland T. Adaptive Behavior Assessment System, Second Edition. Psychological Corporation; 2008.
37. Anderson Baines K, McMartin Heeringa H, Martin AW. Assessment of Language -Related Fu nctional Activities. Pro -Ed; 1999.