"Bottom of My Own List:" Barriers and Facilitators to Mental Health Support Use in Caregivers of Children with Neurodevelopmental Support Needs.

This study investigated barriers and facilitators to mental health service use (e.g., interventions, educational programs) in caregivers of children with neurodevelopmental disorders and/or neurodevelopmental problems, as they experience high levels of distress and low help-seeking behaviour. Caregivers of children aged 0 to 12 with neurodevelopmental disorders and/or neurodevelopmental problems (N = 78) completed a mixed-method online survey about their mental health and service use. Caregiver-reported psychological distress and mental health service use were positively correlated. Most participants (66.2%) were above the clinical cut-off score for anxiety, depression, or caregiving stress; of these participants, 45.7% had not accessed mental health services for themselves within the past year. Lack of time and difficulties arranging childcare were noted barriers; patient-oriented suggestions for service improvement were provided. The findings add novel information on factors to increase mental health service use in this population. Recommendations for clinical practice for those practitioners who provide services for children with neurodevelopmental disorders and/or neurodevelopmental problems are included.

Use of health, education, and social services by individuals with fetal alcohol spectrum disorder.

BACKGROUND: Fetal Alcohol Spectrum Disorder (FASD) is the leading cause of intellectual disability in western society, presenting a significant burden on health, education and social services. Quantifying the burden of FASD is important for service planning and policy and program development. OBJECTIVE: To describe the health, education and social service use of individuals with FASD to provide an indication of the burden of service use of the disorder. METHODS: Using a matched-cohort design health, education and social service data were linked with clinical records on individuals 6+ years diagnosed with FASD between 1999/2000-2009/10 (N=717). Matching was 2:1 with a general population (gPop) and asthma group by age, sex and area-level income. Adjusted rates and relative risks were calculated using Generalized Linear Models. RESULTS: Hospitalizations were higher in the FASD compared to gPop (adjusted relative risk=3.44 (95% confidence interval=2.29, 5.17)) and asthma (2.87 (1.94, 4.25)) groups, whereas for physician visits and overall prescriptions, the FASD group differed from only the gPop group (1.58 (1.34, 1.84); 1.44 (1.22, 1.72), respectively). Antibiotics, pain killers and anti-psychotics were similar across groups whereas antidepressants and psychostimulants were higher in the FASD group (antidepressants: FASD vs. gPop 8.76 (2.82, 27.21); FASD vs. asthma 2.10 (1.15, 3.83); psychostimulants: FASD vs. gPop 5.78 (2.89, 11.57); FASD vs. asthma 2.47 (1.37, 4.47)). Attention-deficit\hyperactivity disorder was higher in the FASD than the gPop and asthma groups (6.41 (3.29, 12.49); 3.12 (1.97, 4.93), respectively). Education and social service use was higher for the FASD than either of the other groups for all measures (FASD vs. gPop and FASD vs. asthma, respectively for: grade repetition 3.06 (1.58, 5.94); 3.48 (1.79, 6.78); receipt of any special education funding 9.22 (6.23, 13.64); 6.10 (4.14, 8.99); family receipt of income assistance 1.74 (1.33, 2.27); 1.89 (1.45, 2.47); child in care 13.19 (5.84, 29.78);10.70 (4.80, 23.88); and receipt of child welfare services 5.70 (4.21, 7.71); 4.94 (3.67, 6.66)). CONCLUSION: The health, education and social service utilization burden of individuals with FASD is substantial, greater than that of individuals in the general population and with chronic illness (i.e., asthma). The findings highlight the need for multisystem supports for those with FASD, and comprehensive prevention programs.

Sleep and sensory characteristics in young children with fetal alcohol spectrum disorder.

BACKGROUND: : Fetal alcohol spectrum disorder (FASD) is a syndrome that results from prenatal alcohol exposure and is defined by significant neurobehavioral impairments. Sleep disruption has been recognized as a clinically important symptom of FASD that has multiple negative effects on the child's health, ability to function adaptively, as well as on family and caregivers. However, few studies have addressed and characterized the sleep problems in this population. OBJECTIVE: : The objective of this study was to characterize sleep in FASD and describe the impact of sensory processing difficulties on sleep patterns in children with FASD. METHODS: : Children with FASD were compared with age-matched typically developing children between 3 and 6 years of age. Sleep was assessed using actigraphy, a sleep log, and the Children's Sleep Habits Questionnaire. The Sensory Profile™, completed by caregivers, was used to evaluate the child's sensory processing abilities. Overall differences in sensory processing were correlated with actigraphic parameters measured in alcohol exposed and control groups. RESULTS: : Data show that children with FASD have significantly more sleep disturbances than typically developing children, including increased bedtime resistance, shortened sleep duration, increased sleep anxiety, and increased night awakenings and parasomnias. Actigraphy reveals a significant difference between groups for sleep onset latency. CONCLUSIONS: : This study demonstrates that sensory processing deficits are widespread in children with FASD and that these deficits are associated with multiple sleep problems. Children with FASD should be screened for sleep-related disorders and would benefit from occupational therapy for sensory-based treatment aimed at sleep regulation and consolidation.