Transcript for
Fetal Alcohol Spectrum Disorder (FASD)

Runtime 00:36:37
Released 9/9/19

Narrator [00:00:02] Welcome to the Emerging Minds podcast.

Sophie Guy [00:00:08] You’re with Sophie Guy, and today I’m talking with Sara McLean about Fetal Alcohol Spectrum Disorder or FASD as it commonly gets referred to. Sara is a registered Psychologist and Adjunct Fellow at the University of South Australia. Sara’s work involves identifying the practice implications of emerging research in the overlapping areas of clinical child psychology, neuropsychology and child protection. Her research translation activities focus on supporting children in the out-of-home care system, where she has been influential in highlighting the role and impact of developmental differences and FASD in this population of children. Sara works as a consultant and is currently part of the Content Development Team for Emerging Minds, National Workforce Centre for Child Mental Health. In today’s episode, we discuss the challenges of diagnosing FASD as well as the benefits that early diagnosis brings in terms of appropriate supports for the child and caregivers.

[00:01:05] Thank you very much for joining me today to have a conversation about your work and experience working with children and families who have Fetal Alcohol Spectrum Disorder.

Sara McLean [00:01:16] You’re very welcome.

Sophie Guy [00:01:16] I’d like to hear first of all, a little bit about your background and how you came to work in this area.

Sara McLean [00:01:23] Well, my background is in child and adolescent mental health originally. So I was a psychologist and working on some specialised units that were supporting children with serious and significant mental health issues. And so I became very interested in why for some of those children there, evidence based approaches weren’t really effective. And so I began a journey of sort of uncovering and unpacking what happens in space of early adversity for children and how that might affect the brain development and how that might affect what kind of therapies and supports we offer them. And as part of that journey in discovering what kind of might work for children in out-of-home care or who’ve experienced early adversity, I was fortunate enough to to meet with Sue Myers, who was a foster carer who introduced me to the area Fetal Alcohol Spectrum Disorder. So I became fascinated with why this was such a poorly understood at the time, area of research or area of children’s needs that was very poorly supported. And so I became interested in learning more about Fetal Alcohol Spectrum Disorder and what that actually means for how we support children.

Sophie Guy [00:02:37] Then perhaps you could tell me a bit about what is how do we understand Fetal Alcohol Spectrum Disorder, FASD as often it’s called. Could you talk a bit about what it is?

Sara McLean [00:02:47] Ok so, Fetal Alcohol Spectrum Disorder is really an umbrella term that’s used to describe a whole range of developmental issues that come out of alcohol exposure in the womb. So it’s a non diagnostic term, much like Autism Spectrum Disorder, that the spectrum is really captures the fact that it’s a whole range of duffers difficulties that children can experience. And historically, it’s been known by different names. So the Fetal Alcohol Spectrum Disorder that really captures the fact that it’s a range of disorders, there are a range of difficulties that young people can have. And they fall under the spectrum of difficulties that happen when a child, that can happen when a child is exposed to alcohol in utero.

Sophie Guy [00:03:34] And how prevalent is that?

Sara McLean [00:03:37] So we really are beginning to understand that it’s a lot more prevalent than we have thought previously. So originally we thought it was a very, very uncommon experience. We thought that a little bit of alcohol exposure during pregnancy was okay and that really maybe about one in a thousand children would experience difficulties as a result of that. We now understand through large scale meta analytic studies and prevalence studies that have been conducted in western countries that the prevalence is likely to fall somewhere between two and five percent. So it’s a lot more common than we have thought previously. And it’s even more common, it seems, in certain populations of children who might be at heightened risk. So when we look at children who are placed in out-of-home care, foster care or residential care, we’re looking at conservatively an estimate of around sixteen, seventeen percent of those children we believe fall on the spectrum of Fetal Alcohol Spectrum Disorder. And in youth justice populations, we believe something around twenty to thirty percent of those young people meet the criteria for Fetal Alcohol Spectrum Disorder. So we’re beginning to understand that it’s really a lot more common than we’ve previously thought.

Sophie Guy [00:04:59] Okay. And is that because it’s being better recognised?

Sara McLean [00:05:04] I think it’s it’s a couple of things. I think there’s. Some really good research done that has heightened awareness around Fetal Alcohol Spectrum Disorder. And we know now a lot more about drinking patterns, so we know a lot more about the fact that women, you know, fifty percent of pregnancies, a woman may be drinking or may it may be unplanned. So because of the quality of the research that’s coming out, we better understand the difference, the different patterns of presentation of Fetal Alcohol Spectrum Disorder. So, for example, when I studied, when I went through my training, I was taught that a child who’s been experience brain damage because of alcohol exposure will have characteristic facial features. So they will have shortened eyes, they’ll have thin lips and they’ll have a flattened philtrum. So that little groove between the nose and the mouth is flattened out. So they were characteristic features of a child who’s been exposed to alcohol and had brain damage as a result.

[00:06:05] So that’s what we were taught going through. So there’s been classically this association between facial features and brain damage. So we thought that if a child doesn’t have those facial features, they probably weren’t affected by alcohol exposure. And now, because of the quality of the research that’s coming out, we understand a lot more that children can have significant cognitive issues and learning issues, and attention issues, even without those facial characteristics. So we’re really uncoupling brain damage from those facial characteristics. So previously a very small proportion of children would have those facial characteristics. And it really depends on the timing of alcohol exposure. Is the child exposed to alcohol when those facial features are developing?

Sophie Guy [00:06:50] So it’s more about timing, not so much dose response of how much alcohol is consumed?

Sara McLean [00:06:55] That’s right. Yes. So we’re beginning to unpack that a little bit more. And we understand that a child can look completely the same as any other child and yet still have significant cognitive issues. And in some ways, that’s really more troubling for a child because it’s really an invisible disability in that case. So the child looks like anybody else. And so it can be very frustrating for parents around why can’t this child behave or what doesn’t this child learn or what’s wrong with memory? So we’re beginning to really understand a lot more about the diverse ways in which Fetal Alcohol Spectrum Disorder can present.

Sophie Guy [00:07:34] Okay. Yeah, I have a question and maybe a little bit devil’s advocate, but it came to my mind, I suppose, in wanting to sort of understand. What is sort of the value in knowing for sure if the effects of Fetal Alcohol Syndrome or Spectrum Disorder look similar or sort of are you know, impacts on cognitive functioning behaviour that could have a whole range of causes. Why is it useful or important to know that alcohol is the cause? I mean, I can obviously understand it from a public health and, you know, for trying to prevent women from drinking. But after that point, is it useful for the child and their sort of trajectory to know that it was really alcohol that was the cause of that?

Sara McLean [00:08:17] Well, I think it is on the whole. I think the literature supports the idea that people really value getting a diagnosis. And what it can mean is the difference between understanding that it’s not about the quality of your parenting, it’s not about the quality of the way that you teach a child. It’s not about the opportunities that you’ve given them. That’s not it’s not about you. It’s about something that’s, that they’ve been born with. And its particularly important for foster parents who can feel blamed when a child when the heck can have difficulties in managing a child’s behaviour that can feel very blamed and isolated around that. And so it’s a real shift in mindset. If you have a diagnosis, you can understand that it’s not that the child’s willfully disobedient. It’s more that they can’t. So it’s a shift from they won’t to they can’t at this stage of their development. They can’t do what you’re asking them to do. They can’t learn what you’re asking them to learn. And so there’s a massive mindset shift. But having said that, it’s also a double edged sword for many parents getting a diagnosis because it means that, okay, there’s a relief, you know now with certainty what’s going on for the child. But it also means that there’s enormous sadness often and grief around what may not be possible for your child moving forward. So it is a double edged sword. But on the whole people do value, really value getting a diagnosis because it means that they have a sense of certainty around what’s going on. And it can mean that it’s not necessarily reflective of their parenting and their love for their child, but it’s more about what what the child can’t do at this moment.

Sophie Guy [00:10:02] And is FASD different to other possible sort of causes of behavioural, cognitive challenges in that they. I mean how much can you work with a child sort of help them gain back some of those capacities? Is it possible for them to sort of with the right therapy an intervention to sort of have normal functioning if you want to call it that? Or is it kind of like a permanent sort of impairment?

Sara McLean [00:10:29] Well, as far as we understand, it seems like that we can’t reverse the effects of alcohol on the brain, on developing brain. What we can do, though, is if we get an early diagnosis, we can put supports around the child that can support them to develop in the optimal way. So first of all, the child feels differently about themselves if they have a diagnosis. They know that it’s something that they’ve been born with. It’s not because they’ve dumb, they’re stupid or anything like that. So that can be a massive help. Then we want to put supports around the child. And mostly that will focus on structuring the environment and making, reducing the cognitive load for children. So it can be really beneficial to understand what it is we’re dealing with. In some ways, like to take up your question, in some ways it is very similar to other disabilities, but in some ways it’s different. So some children may have intellectual disability. Some children may have sensory issues, they may have memory issues, they may have learning difficulties. So there are some similarities between learning difficulties and this similarities between Fetal alcohol and children with intellectual disability. But there are also differences in that it seems that children who have Fetal Alcohol Spectrum Disorder are living with that condition, it’s characterized by a lot of variability. So one day they might be able to do something and the next day they don’t. So it’s almost as though some days the wiring in the brain works well and other days it doesn’t. So I think that’s one of the things that parents find the most frustrating. And so to really understand that Fetal Alcohol Spectrum Disorder is similar in many ways to lots of other developmental conditions, but it also has unique challenges. So really understanding that and educating professionals and parents around the nature of that condition I think can be really helpful.

Sophie Guy [00:12:29] It sounds like it must be quite tricky to arrive at that diagnosis and just filter out the other possible causes or things going on. How do you diagnose FASD?

Sara McLean [00:12:40] Yeah, so there’s a lot of work going on internationally around getting greater clarity around the diagnostic criteria. In Australia, there are clinics that have been established by the government or by private providers that can undertake the diagnostic process for you, or you can connect with some of the professionals that have been trained in that kind of approach. But broadly speaking involves paediatric assessment. So basically looking at how the child’s developing generally, the process would involve doing genetic screens so that we can rule out other possible causes, genetic causes of difficulties that the child might be experiencing. They might, you would, it would involve a thorough neurocognitive assessment. So we’d be looking at ten domains of functioning. And for the child to get a diagnosis of Fetal Alcohol Spectrum Disorder, they’ll need to be significantly behind in at least three of those domains of functioning. So the actual assessment process is really quite comprehensive. And at the end of that process, you would hope that you would get a very good understanding of the child’s profile, developmental profile. Where they’re at at this moment in their life. And also that would lead then to some recommendations around how to support the child’s development moving forward.

Sophie Guy [00:14:06] How would you, because there must be lots of kids who haven’t had a mother in utero who didn’t drink and could have all those patterns and functioning levels and things going on. How do you still pull apart that it’s alcohol and not something else?

Sara McLean [00:14:22] So it’s around asking about alcohol exposure in utero as well. Yeah, absolutely. And then the genetic screening, because it can present very similarly to some other genetic conditions. So the paediatricians who have been trained in Fetal Alcohol Spectrum Disorder assessment will do that kind of profiling and looking at facial features as well. They’ve got an assessment protocol around that. And then the neurocognitive features are generally assessed by a psychologist or speech therapist or an occupational therapist, and they’re looking at characteristic patterns. And so while there are some similarities with autism spectrum disorder, for example, the nature of social difficulties. Slightly, it is different between the two groups. So there are some nuances that will come out as part of that neurocognitive assessment that make it more clear what kind of difficult to we where we’re dealing with. And that’s then triangulated with no parent checklists and teacher checklists and so on. And so we’re looking at information from a range of sources to come up with a diagnosis. But it is quite a comprehensive process.

Sophie Guy [00:15:36] And you alluded to before that there used to and possibly probably there still is out there, sort of an idea that a small amount of alcohol during pregnancy is safe. What actually is the current evidence based position on that?

Sara McLean [00:15:52] Well, I think the the evidence base is still evolving around that. So there has been research that showed a small amount of alcohol probably does no harm. However, the bulk of the, if we look at the research on the whole, we don’t really have enough evidence to say one way or another. We do know that exposure to alcohol, the more alcohol you’re exposed to in utero, the more likely that it will affect development, not just the brain development, but the development of all the organs of the body. So the National Health and Medical Research Council, for that reason, recommends that the safest option is not to consume any alcohol at all during pregnancy. So while there is still no definitive evidence, then the national guidelines do recommend that you advise women not to drink any alcohol at all during pregnancy.

Sophie Guy [00:16:46] Okay. I’m curious to know what’s sort of the youngest age you could start to identify and diagnose FASD?

Sara McLean [00:16:53] Well, there’s not been any age set formally. However, anecdotally, I can tell you that one of the criteria that we use to diagnose Fetal Alcohol Spectrum Disorder is difficulty with executive functioning. So that’s ability of the brain to coordinate a set of functions to, in order to initiate attention, sustain attention, plan and monitor behaviour and benefit from feedback, amongst other things. So the executive functions are a set of coordinated functions in the brain. The reason I mentioned that is because we know that executive functioning doesn’t. it develops in leaps and bounds around the age of seven, six or seven. So some of the research is showing us that when we assess children at the age of three or four, we might be getting a profile that’s not dissimilar to other children. But when we assess them at seven or eight, that’s when the difficulties start to top start to show up. So for that reason, some clinics don’t do assessments before the age of eight. Just because you’re more likely to pick up the difficulties that children are having around that age. So that corresponds, of course, to the start of school, the first grade around that age that we we do typically see that children with learning issues start to come to the attention of the teacher and start to have difficulty keeping up with other children, start to have those social difficulties.

Sophie Guy [00:18:30] Okay. Yeah. And then ideally, what does the what does the intervention or working with therapy children look like?

Sara McLean [00:18:40] So because Fetal Alcohol Spectrum Disorder can present in a range of ways. It’s about understanding that child’s unique profile. What are the areas of strength for that child and what are the areas that they struggle with. And putting in supports for those areas that they struggle with to reduce their cognitive load. So it might be visual supports, it might be lots of repetition, it might be reminders, visual reminders, those sorts of things. But generally speaking, the strategies are around changing our expectations of children. So realising that they can’t, not that they won’t. So that’s a massive mindset. Shift around realising that you’ve got a child who has a significant issue. And for them at the moment, they can’t comply with what you’re asking them to do. They may not be able to learn in the same way as other children. So a lot of work is around processing that and what that might mean for the child. Generally speaking, then, the other thing that we focus on is structuring the environment and being able to simplify and supervise around children. So being able to create safe environments for children.

[00:19:57] So that would include things like putting physical barriers for children that can’t predict consequences of their actions if they’re going to go out into a room that’s dangerous, like a kitchen or whatever. It might mean, putting up visual reminders, structuring the the environment. It might be unpacking daily routines. So, for example, you might use picture cues for a routine as simple as brushing your teeth in the morning. So you might need visual cues to help that child sequence and play in those events. So it’s structuring, the environment as much as possible to make the environment easier on that child and reduce their cognitive load. It’s about educating all the adults in that child’s life. So it’s really, really important for teachers to understand about Fetal alcohol spectrum disorder, for case managers and for all the professionals in that child’s life to really understand what’s going on for that child. And then it’s about lots and lots of repetition and not expecting that if they can do something one day, that they’ll be up to do it the next day. Because on that second day, their brain might be fatigued and they can’t, that information doesn’t get through in the same way that it did on the first day. So it’s being able to be, to live with predictable unpredictablility on behalf of the child. To expect the unexpected, because the Fetal Alcohol Spectrum Disorder is really characterized by really fluctuating levels of ability from day to day. So a lot of is–it around the mindset shift to really understand that like if as though a child had a broken leg, you wouldn’t expect them to climb stairs by themselves in the same way, we have to put those steps really close together for a child with Fetal Alcohol Spectrum Disorder, so that they can experience success.

Sophie Guy [00:21:49] What happens to these kids when they grow up and become adults?

Sara McLean [00:21:53] We don’t know a lot about that. There has been some longeitudinal research which shows which tells us about the supportive factors that help them to succeed as adults. And one of that, one of those is early diagnosis. One of those is having a consistent and responsive caregiver. So what if we can do to support the caregiver to, whether it’s a parent or it’s a foster parent, to stay involved and connected to that child’s life is really important. And other features that, other things that can help a child to be successful as an adult really then becomes around the systems and services that support a child. The more that a school can understand about Fetal Alcohol Spectrum Disorder and adapt their strategies accordingly; the more that an employer can understand about a potential employee’s memory difficulties and it and change their expectations; the more that’s the social society can become supportive of Fetal Alcohol Spectrum Disorder, the better the outcomes are likely to be for these young people. Because we know that children’s mental health and wellbeing doesn’t happen in isolation. It happens in the context of community, in the context of our social systems. And so for many young people, becoming employed is it is a challenge. Maintaining a job is a challenge because of a lot of the cognitive issues that can go along side, you know, staying motivated, staying organised, managing money, all those sorts of things. For some people, they’ll always need support with that. And some young people can go on to experience success in structured workplaces. So there’s a wide variety because not all children are affected in the same way.

Sophie Guy [00:23:48] Ok, so I asked you about sort of safe levels of alcohol consumption. And I also wanted to ask some questions around the public health angle on this. And yeah I wanted to ask what, if any, public health campaigns exist to try and prevent kids developing FASD in the first place?

Sara McLean [00:24:10] Yeah, I think The Foundation of Alcohol Research and Education has run some really good campaigns, one of which is called Women Want to Know. And they have produced some really great resources around demystifying the process, if you like, around asking women about alcohol consumption during pregnancy. And so they’ve got some concrete resources that practitioners can use to ask about alcohol use in pregnancy. So that’s been a really strong campaign.

Sophie Guy [00:24:45] Was that directed at GPs or Obstetricians?

Sara McLean [00:24:48] Yeah at medical professionals largely, I think. And there’s also they’ve also run a really great campaign called Pregnant Pause, which supports, which encourages men to have a period of abstinence during pregnancy of that of their partner as well. Because we know that one of the big influences of women drinking during pregnancy is men. Their partner’s drinking during pregnancy. And often women feeling pressured, subtle or otherwise to continue to drink during pregnancy. So really highlighting the fact that men have a role, an important role to play around the future of their children as well. And so those are two of the main health promotion strategies that I think have been really, really great initiatives.

Sophie Guy [00:25:45] Now, I might shift to asking you a few things around what might be helpful for practitioners who don’t necessarily have a lot of it or feel that a lot of experience in FASD. What might be sort of helpful things for them to know? And so I was interested how a practitioner might, if they suspect that that child might have FASD or something worth exploring, how can they go about effectively engaging parents and asking in a sensitive way? Do you have any thoughts around that?

Sara McLean [00:26:18] Well, I think in any counselling professional client relationship, the main value that you bring to that is the quality of your relationship. So I think those things can be addressed in the context of a supportive relationship. So I think one of the things that we can connect with with pregnant women or with women who’ve had children is around their hopes and aspirations for their children. And I think there can be an alliance between a therapist and a woman around that. And so I think that’s a really good way to introduce the topic of Fetal Alcohol Spectrum Disorder around curiosity as to whether they are interested in learning more about the impacts of prenatal events on children, whether they would be interested in learning more about Fetal Alcohol Spectrum Disorder, whether they would be interested in talking around their experiences of that. So it’s one of those things I think that really comes down to fundamentally to your relationship with that woman. And as most practitioners do, if you can create a safe space, I think women the research indicates to us that women really want to talk about alcohol use in pregnancy. So we shouldn’t be afraid of that, raising that topic.

Sophie Guy [00:27:40] Yeah, I imagine it must be really quite a tricky one, though, because obviously it’s something that’s happened in the past and can’t be changed. And that must be quite a difficult process for a woman to confront.

Sara McLean [00:27:53] Yeah, I imagine the most, the most important thing, I think is that that really that non blaming approach. Often women and I guess it’s one thing to assume that, it’s important to assume that women didn’t know the impact, potential impact of alcohol because many women don’t know the potential impact of alcohol when they’re pregnant. So we can’t always assume that it’s an intentional act as well. So I think that non blaming approach is really, really important to hold that in mind in engaging with women about this topic.

Sophie Guy [00:28:29] Okay. So if a practitioner and we are speaking very broadly here, but someone who is not an expert in Fetal Alcohol Spectrum Disorder, did suspects that that might be going on. What’s the way forward for them? What do you think is the next thing they should do? Is it important to sort of refer to a service that does specialise in this area?

Sara McLean [00:28:51] Or practitioners can find a lot of information on the FASD hub, which is like a clearinghouse of information about Fetal Alcohol Spectrum Disorder that talks about, gives you information about the diagnostic criteria. And gives you information about where the clinics are around Australia and also can connect you with professionals who are FASD informed or have undertaken the training or are qualified to give the support around ongoing support around Fetal Alcohol Spectrum Disorder. So the FASD hub is a really good place to start for information. Or NO FASD Australia is a really good website. So NO FASD Australia is the peak body for children and families living with Fetal Alcohol Spectrum Disorder. So they’re really good place source of information and support for practitioners. So I think if there is this suspicion of Fetal Alcohol Spectrum Disorder or there’s a known history of alcohol consumption during pregnancy, those places are really good sources of referral. And it really depends on what jurisdiction of Australia you live in as to how easy it will be to access those diagnostic services, diagnostic and support services. But pretty well in all jurisdictions there is some form of support available now for Fetal Alcohol Spectrum Disorder. So things have really improved in the last couple of years around that space. So practitioners don’t need to feel alone in that support.

Sophie Guy [00:30:21] Okay. Is there anything that I haven’t asked you that you think is important to add to this conversation?

Sara McLean [00:30:29] Well, I think it’s important for practitioners to realise that how common alcohol exposure is, and how likely that it is to result in some level of difficulty for a child, either physical differences, developmental differences, cognitive differences, attentional problems, sleep disorders, sensory issues. But for practitioners also just to highlight the fact that Fetal Alcohol Spectrum Disorder is an invisible difficulty. It doesn’t present in the way that, it is quite often not associated with any physical differences, any differences in face development, or it doesn’t necessarily come with a raft of health issues, although it can. So and it can be present as ADHD and it can present as autism, and it can present as intellectual disability, and it can present as a mental health condition. So I think I’ll just encourage practitioners always to have in their mind that prenatal alcohol exposure may have a role to play in the kind of issues that children and family are dealing with. Not that it necessarily will, but it can have a role. And that, I guess, just encourage them to remember that alcohol consumption is a lot more common than we perhaps think it might be. And that the presentation can look like any other condition. So it’s important to ask and explore around Fetal Alcohol Spectrum Disorder, around alcohol exposure, and to try and get that information if you can.

Sophie Guy [00:32:19] Sounds like it’s almost an important sort of universal conversation to have with any family that might be bringing facing challenges with their children.

Sara McLean [00:32:29] Yeah, yeah. And I think that’s really the recommendation that’s been made recently is around always asking whenever possible. And if you are early childcare professional also to use those kind of standardised tools like the AUDIT see to capture the amount of drinking and to capture that and to document that. Cause certainly one of the issues for children in foster care is that by the time they’re seven or eight and presenting for diagnosis and presenting with a range of issues, we may not have a good sense of their child’s history. We may have lost that if it’s not recorded at the time. So we really encourage professionals to document alcohol consumption where there is a suspicion or where there is confirmed alcohol consumption down the track. It becomes a very important piece of information to have to to set up the best sports for children.

Sophie Guy [00:33:26] So as part of your role at the National Workforce Centre for Child Mental Health. I know you’ve been involved in developing a suite of resources around Fetal Alcohol Spectrum Disorder. Could you just tell us a little bit about those resources and what people can find?

Sara McLean [00:33:38] Sure. So I’ve developed a series of five resources just really to touch on the main issues around Fetal Alcohol Spectrum Disorder. So really just describing what Fetal Alcohol Spectrum Disorder is and why it’s an important issue for practitioners to understand about. And that it’s the number one preventable cause of non-genetic and developmental issues in children. Then I’ve talked a little bit about the connection between Fetal Alcohol Spectrum Disorder and mental health for children. And so that often children who have who are living with Fetal Alcohol Spectrum Disorder can go on to develop mental health issues because there’s a chronic disconnect or mismatch between the way that they need to process the world and the way that the world is structured, so what we expect from them. So and that causes some issues for young people. So it’s really, I think, important to highlight the potential for mental health issues and in young people living with Fetal Alcohol Spectrum Disorder. Then I’ve got a resource that’s around some of the issues that young people can experience. So it really outlines the kind of challenges they might have with everyday memory, executive functioning, sensory issues, sleep issues, and how we might support young people with those issues. And there’s also a resource about working with families so that once they have received a diagnosis, how do we go on to. What are some of the common issues that they experience around diagnosis and what are they looking for from professionals in terms of support. And then the fifth resource is around how can we, as service providers and members of a sort of service system, members of the community support young people living with Fetal Alcohol Spectrum Disorder? Is there anything we can do to change the kind of services and the way that we offer services so that they’re more aligned to the needs of children with Fetal Alcohol Spectrum Disorder? So really five resources that just touch on a little bit on each of those areas to give practitioners an overview of some of the key issues involved in supporting children.

Sophie Guy [00:35:46] Yeah. And I’ve had a look at them. They are really great, clearly written and concise documents. And so I think I would certainly encourage anyone who is interested in delving into a bit more detail into FASD that they go and check them out. Thanks, Sara.

Narrator [00:36:04] Visit our Web site at to access a range of resources to assist your practice. Brought to you by the National Workfor Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.