Mental Health and Affect Regulation Impairment in Fetal Alcohol Spectrum Disorder (FASD): Results from the Canadian National FASD Database.

AIMS: Individuals with fetal alcohol spectrum disorder (FASD) frequently have challenges with regulating emotional arousal, or affect regulation (AR), and experience high rates of mental health disorders. This study examined children and adults with FASD to investigate the relationship between AR impairment and several mental health problems and diagnoses. METHODS: Data from the Canadian national FASD database was used for analysis. Seven mental health diagnoses, including attention-deficit/hyperactivity disorder, post-traumatic stress disorder, conduct disorder, attachment disorder, intellectual disability, and language disorder were examined. A history of suicidality was also examined. The prevalence of these mental health problems in individuals with and without AR impairment was compared. RESULTS: Individuals with FASD and AR impairment were significantly more likely to be diagnosed with conduct disorder (OR 4.8), attachment disorder (OR 6.1), or post-traumatic stress disorder (OR 8.1) when compared to those without AR impairment. They were also more likely to have a history of suicidality (OR 8.6). AR impairment was most commonly found in those with greater overall neurodevelopmental impairment. Having AR impairment was associated with receiving a diagnosis of FASD at a later age, but was not related to gender, intellectual disability, or language disorder. CONCLUSION: AR impairment is strongly related to several mental health diagnoses in those with FASD and presents some promising possibilities for targeted early intervention.

Adults with Fetal Alcohol Spectrum Disorder: Factors Associated with Positive Outcomes and Contact with the Criminal Justice System.

BACKGROUND: Adults with FASD are at increased risk for contact with the criminal justice system (CJS). To date, there has been limited research devoted to development of supports for adults with FASD and it is unclear what supports are required to improve outcomes and reduce CJS contact. OBJECTIVES: To examine the services and supports experienced by a small group of adults with FASD living in both rural and urban locations in Ontario, and their contact with the CJS. METHODS: A sample of 14 individuals with FASD and 11 support persons participated in the study. Semi-structured interviews were conducted and coded according to key themes which were qualitatively analysed using quotations that supported each key theme. A reliability analysis was conducted for the interview coding. RESULTS: Early diagnosis and lower substance use were found to be factors associated with reduced contact with the CJS. Participants reported on: knowledge of their diagnosis and caregiver training and education about FASD; interdependence; routine, structure, and supervision; evidence of a strength-based approach; effective communication; and collaborative services. Few participants had received training and education around FASD and further research is needed to determine the training required for more successful interventions and outcomes. CONCLUSION: As has been found previously, early diagnosis of FASD is associated with more positive outcomes including reduced amount of contact with the CJS. It is likely that early diagnosis leads to the receipt of more supports throughout childhood and contributes to a better understanding of FASD by family and caregivers.

Diagnosing FASD in adults: the development and operation of an adult FASD clinic in Ontario, Canada.

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 collaboratively 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.