Identifying Fetal Alcohol Spectrum Disorder and psychiatric comorbidity for children and youth in care: A community approach to diagnosis and treatment

Abstract

BackgroundSeveral challenges exist when making a diagnosis of Fetal Alcohol Spectrum Disorder (FASD) and identifying co-morbid psychiatric illness, particularly for children and youth accessing child welfare services. Here, we describe an integrated three-phase approach to the identification of FASD and psychiatric comorbidity for children and youth in care, consisting of: (1) completion of a standardized neurobehavioral screening tool by a child protection worker (CPW); (2) assessment by a pediatrician, including facial measurements and; (3) integration of findings in a psychiatric assessment. Main FindingsThe majority of participants (14/18, 78%) of youth who were suspected by a CPW and pediatrician of a diagnosis of FASD using the screening tool were determined to have met criteria. A diagnosis was made in all cases where there was confirmed history of prenatal exposure and a majority of these youth were found to have sentinel facial features of FASD. Psychiatric comorbidity was diagnosed and treatment recommendations made for all children and youth referred. ConclusionsThis study supports the utility of an integrated community approach to diagnosing and treating comorbid psychiatric disorders in FASD by employing existing child protection and physician services in a community setting. Based on these preliminary findings, we encourage that youth who access formal care systems be screened for FASD by their CPW and are provided with appropriate pediatric and psychiatric assessments to clarify the diagnosis, while also identifying comorbid psychiatric illness to target appropriate interventions.