Australia as a whole, including Western Australia, does not currently have a screening system of a diagnostic tool to identify those at risk of foetal alcohol spectrum disorders (FASD), or those already living with the condition. This has impacted attempts to determine prevalence of FASD.
What's more, in regards to the more easily diagnosable and more physiologically recognised foetal alcohol syndrome (FAS), studies on Western Australia show that only 12-16% of healthcare professionals knew the four diagnostic features of FAS. As FASD is less identifiable than FAS it is likely that there is an even greater impact of under-reporting for this condition.
Prevention by screening
One way to reduce the number of cases of FASD would be to utilise screening to identify and refer populations of women of child-bearing age who are planning on getting pregnant, or who are already pregnant, that are also at risk of an alcohol use disorder.
However, a report on FASD found that less than 50% of healthcare professionals routinely ask about alcohol use during pregnancy. This finding prompted a recommendation to the Ministry of Health that women should be screened at each antenatal appointment and that women at risk of heavy alcohol use should receive intervention counselling.
Barriers to diagnosis
The under-reporting of FASD may be due to a difficulty making the diagnosis, a lack of awareness and recognition, a lack of availability of specialists in certain areas and a difficulty to confirm maternal alcohol use during pregnancy. In addition, early diagnosis of FASD can be difficult as evidence of brain damage often isn't evident until the child reaches school age, when learning and behavioural difficulties are more noticeable. This also means that misdiagnosis is common where children may instead be diagnosed with attention deficit hyperactivity disorder ADHD or mild autism.
Evidence suggests that some paediatricians may not being prepared to deal with a diagnosis or may be reluctant due to the associated stigmatisation. In line with this, Michelle Bishop, a Inclusive Education Consultant with the Association of Independent Schools of WA (AISWA), advised that there has historically been a difficulty in getting paediatricians to diagnose FAS/FASD on paper, and attributed this to a lack of clarity around the diagnostic factors
Benefits of early diagnosis of FASD
Being undiagnosed often causes misunderstandings and confusion for both the individual concerned and their friends, family and community. Much needed resources, support and assistance to help those affected manage the condition is missed out on and this can lead to the development of secondary behaviours and the stereotypical labelling of that individual. In addition, the consequences of FASD increase with adulthood as there is less social tolerance for the behaviour.
Early diagnosis of FASD could have many benefits including:
Approach to diagnosis
The Australian FASD Collaboration has developed a diagnostic tool for FASD and funding has been allocated by the government for an action plan to finalise the tool and develop clinical guidelines for use. Following this it will need to be trialled by healthcare professionals. However, in order for diagnosis to be successful a multidisciplinary approach is required. The Department of Health advised that: ‘Developmental delays or disorders can manifest as a single issue or as a cluster of issues requiring multidisciplinary services’. Such an approach would require a combination of inputs from paediatricians, GPs, nurses, social workers, psychologists, speech and language therapists, child care assistants... the list goes on.
What's more, in regards to the more easily diagnosable and more physiologically recognised foetal alcohol syndrome (FAS), studies on Western Australia show that only 12-16% of healthcare professionals knew the four diagnostic features of FAS. As FASD is less identifiable than FAS it is likely that there is an even greater impact of under-reporting for this condition.
Prevention by screening
One way to reduce the number of cases of FASD would be to utilise screening to identify and refer populations of women of child-bearing age who are planning on getting pregnant, or who are already pregnant, that are also at risk of an alcohol use disorder.
However, a report on FASD found that less than 50% of healthcare professionals routinely ask about alcohol use during pregnancy. This finding prompted a recommendation to the Ministry of Health that women should be screened at each antenatal appointment and that women at risk of heavy alcohol use should receive intervention counselling.
Barriers to diagnosis
The under-reporting of FASD may be due to a difficulty making the diagnosis, a lack of awareness and recognition, a lack of availability of specialists in certain areas and a difficulty to confirm maternal alcohol use during pregnancy. In addition, early diagnosis of FASD can be difficult as evidence of brain damage often isn't evident until the child reaches school age, when learning and behavioural difficulties are more noticeable. This also means that misdiagnosis is common where children may instead be diagnosed with attention deficit hyperactivity disorder ADHD or mild autism.
Evidence suggests that some paediatricians may not being prepared to deal with a diagnosis or may be reluctant due to the associated stigmatisation. In line with this, Michelle Bishop, a Inclusive Education Consultant with the Association of Independent Schools of WA (AISWA), advised that there has historically been a difficulty in getting paediatricians to diagnose FAS/FASD on paper, and attributed this to a lack of clarity around the diagnostic factors
Benefits of early diagnosis of FASD
Being undiagnosed often causes misunderstandings and confusion for both the individual concerned and their friends, family and community. Much needed resources, support and assistance to help those affected manage the condition is missed out on and this can lead to the development of secondary behaviours and the stereotypical labelling of that individual. In addition, the consequences of FASD increase with adulthood as there is less social tolerance for the behaviour.
Early diagnosis of FASD could have many benefits including:
- Enabling access to interventions and resources that may mitigate the development of secondary problems such as mental health problems, interrupted school experience, unemployment, trouble with the law etc.
- Appropriate intervention, counselling and treatment for the mother may prevent the subsequent children being affected by FASD.
- Prompting caregivers to seek diagnosis and support for other previously undiagnosed siblings.
Approach to diagnosis
The Australian FASD Collaboration has developed a diagnostic tool for FASD and funding has been allocated by the government for an action plan to finalise the tool and develop clinical guidelines for use. Following this it will need to be trialled by healthcare professionals. However, in order for diagnosis to be successful a multidisciplinary approach is required. The Department of Health advised that: ‘Developmental delays or disorders can manifest as a single issue or as a cluster of issues requiring multidisciplinary services’. Such an approach would require a combination of inputs from paediatricians, GPs, nurses, social workers, psychologists, speech and language therapists, child care assistants... the list goes on.
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