needed , but resource is then used efficiently .
Importance of early recognition Numerous secondary disabilities have been linked to FASD . Due to FASD presenting with one of its many recognised comorbidities , it can often be a hidden presentation . 20 When unrecognised , these secondary issues can have significant lifelong effects .
The classic study was completed in the early 2000s and carried out over 30 years . 17 This identified that in people who were not identified early , then presented late to clinical services , poor secondary outcomes were common . These included 90 % having mental health problems , over 50 % experiencing some form of confinement during their life and over 50 % having a disrupted school experience ; 30 % of the same group went on to have their own addictions . 17
By identifying the individual early , a different trajectory can be created , thereby leading to better lives for these individuals . Interventions continue to develop . Interventions in the past were more generic , but as research continues , these interventions are directed more specifically at those with FASD .
Another factor that is increasingly being recognised is the importance of early recognition and intervention for an individual ’ s vulnerability associated with FASD to reduce the impact of abuse and neglect . Complex trauma models are increasingly being investigated ; with this comes the understanding that psychological challenges overlay neurological functioning , which cancan further impact on an individual ’ s behaviour and presentation . Even if the neurological deficits remain , understanding the person ’ s needs and not perpetuating extra trauma leads to a better quality of
21 , 22 life overall .
Interventions What remains vital is not just the diagnosis , but also an understanding of an individual ’ s function and then subsequently what interventions can be offered to change an individual trajectory . This can be led by the diagnosis , pointing towards the specific needs . These interventions can also be multidisciplinary . Pharmacological interventions alongside social and psychological interventions offer the best overall approach to improving an individual ’ s presentation .
For example , several studies have suggested that by understanding the individual with FASD can help modify medical treatment pathways . One such was a consensus pathway for comorbid ADHD ; this identified that routine approaches for ADHD might not always be appropriate . Based on the wider profile and comorbidity linked to the FASD , treatments would need to be changed to meet the individual ’ s needs . 23
The same can be said for psychological interventions , where it is understood that due to underlying problems with emotional recognition and the underlying cognitive deficits , some emotion-focused approaches do not work as well as educational approaches designed to build on strengths and support teaching around the deficits . 24 Several interventions have been created and continue to be developed . Parenting involvement is an area where there is great scope for immediate intervention that could have significant benefits . These are examples of specific interventions for FASD that are currently going through testing and clinical trials .
Conclusions FASD is a common condition that presents often as an invisible disability . Because superficially , individuals can appear to function reasonably well and test reasonably well in clinical settings , this can belie an individual ’ s actual level of function when wider factors are borne in mind . Complex cognitive processing is often missed , leading to attributions of difficulty and blame which may be inappropriate . It is only by early recognition and bespoke individual intervention that change can be made .
KEY POINTS
• FASD is a condition that is common but often unrecognised .
• The facial features represent the more recognisable parts of the spectrum but not necessarily the most severe .
• FASD can have a complex presentation that requires a multidisciplinary approach .
• For simple cases , it may be possible for an individual practitioner to collate multidisciplinary assessments .
• Interventions will need to be tailored to the needs of people with FASD to change the trajectory of people ’ s lives .
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