Newsletter for the Rotary Club of Western Endeavour - Issue No.: 1116 Issue Date: 21 Apr, 2024

Dr John Wray, developmental paediatrician and part of the team working to Make Fetal Alcohol Syndrome Disorder (FASD) History in Leonora, spoke to members of our club and the Rotary Club of Osborne Park last week.

Fetal Alcohol Spectrum Disorder (FASD) is a lifelong condition characterised by severe neurodevelopmental impairment due to prenatal exposure to alcohol. There is no cure. Preventation is the answer.

Dr Wray worked as clinical director of child development for 15 years and every six months, child development statistics got worse. He wanted to turn these statistics around and prevent what is a preventable disorder.

Dr Wray is working with PATCHES, a child development service providing diagnosis and therapy to children in hard to reach populations and places (remote communities, justice and child protection systems). Telethon Kids Institute has also supported strategies to Make FASD History in the Kimberley and Pilbara. Clinical and Research models operate synergistically with clinical services an important aspect of FASD prevention.

Clinical and prevention models are working together to form the Leonora model. PATCHES is providing a diagnostic service and aims to develop a therapy to children in Leonora. Children are identifed by the local school. Rotary fund the service and the prevention model.

FASD is a diagnosis of exclusion. There are many causes of development disability however, prenatal alcohol is the leading preventable cause.  Not all children with developmental impairment or disability have FASD. Some do and formal diagnosis is important. FASD is preventable. Early life trauma and attachment disorder often co-occur.

Facial features of FASD include short eye openings (palpebral fissure length), smooth philtrum (gutter between nose and lip), and thin upper lip. Facial features are not necessarily used in assessment and not all children display these features. Assessment needs to be comprehensive as there is no biological test.

The consequences of FASD for the child, the family and society are a spectrum of difficulties including:

• poor growth,
• learning problems - poor vocabluary, poor memory, poor impulse control
• predisposure to mental health problems, further abuse, poor choices, poor employability, welfare reliance, incarceration



Dr John Wray with Pres Peter and Pres Byron, Bruce Dufty and Dawn Brodie

FASD prevalence in 'high risk' populations:

• Where data exist for Indigenous Australian populations, prevalence is between 2 and 100 times higher than in non-indigenous communities (Bower et al., 2000; Harris & Bucens, 2003; Mutch, Watkins & Bower et al., 2014) 
• Lililwan Project - FASD prevalence in the Fitzroy Valley 194 per 1000 school-aged children (Fitzpatrick et al. 2017)
• Banksia Hill Study - FASD Prevalance 36% (27 - 46%) of juveniles in detention in Western Australia (Bower et al. 2018)

The Leonora team is less focused on research. The team is using a multi-pronged approach to prevention:

• Level 1 - Mass media - broad wareness-building and health promotion efforts > supportive alcohol policy
• Level 2 - Health promotion - discussion of FASD/alcohol with all women of child-bearing age and their families > therapy and support programs
• Level 3 - Antenatal support - support of pregnant women with alcohol and other health/social issues > research and evaluation
• Level 4 - POstnatal support - postpartum support for new mums and support for child assessment and development > FASD diagnostic clinics

PATCHES, a service delivery approach to diagnosis and therapy includes behavioural therapy, clinical neuropsychology, clinical psychology, clinical social work, developmental paediatrics, exercise physiology, generalist physchology, occupational therapy, physiotherapy and speech pathology as therapy after diagnosis. 

Providing therapy in remote areas is challenging with language being part of the challenge. Children in Leonora haven't been able to access the required services in Kalgoorlie so having the services to hand will make a big difference and assist affected children make the best of their often extraordinary potential.

REMEMBER:

• FASD is preventable; and
• FASD doesn't care where on the finaancial or social scale you come.

To read more about the team's progress click on the link and choose the Making FASD History in the Fitzroy Valley video listed in the right hand column.