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G506(P) An integrated neuropsychiatry/paediatric assessment clinic for children with prenatal alcohol exposure: developmental, psychiatric and neuropsychiatric diagnostic outcomes in community secondary care
  1. EJL Weisblatt1,2,
  2. G Gregory1,
  3. A Danieli3
  1. Integrated Children’s Services, Cambridgeshire and Peterborough NHS Foundation Trust, Peterborough, UK
  2. CLaRA, Department of Psychology, University of Cambridge, Cambridge, UK
  3. IRCCS E Medea, Polo di Conegliano, Treviso, Italy

Abstract

Background Prenatal alcohol exposure is associated with neuropsychiatric difficulties (Foetal Alcohol Spectrum Disorder, FASD) and also with physical abnormalities (Foetal Alcohol Syndrome, FAS). A retrospective audit in a community paediatric service found 3.5% of children fulfilled criteria for FAS or FASD; for those in care 27.2%. They did not routinely have neuropsychiatric or psychological assessment although paediatric patients with complex needs benefit from joint management by co-located mental health and paediatric staff. Children with complex needs are often referred to multiple services and multiple teams within a service causing delays and absence of an overall specialist assessment and formulation.

Aim To implement an integrated community clinic for clinical and developmental diagnostic assessment of children with prenatal alcohol exposure presenting with emotional, behavioural or developmental difficulties.

Method An integrated clinic was set up for children with known prenatal alcohol exposure, with developmental neuropsychiatrist, community paediatrician and psychologist. Children received: medical assessment and investigation; WISC-IV cognitive assessment; Conners ADHD screening questionnaire; Social Communication ASD screening questionnaire; BRIEF executive function questionnaire; neuropsychiatric clinical assessment. Further assessments were carried out as clinically indicated. Diagnostic formulation included: cognitive and executive function; developmental disorders; FAS/FASD if present; psychiatric disorders; attachment issues. Specific treatment needed following diagnosis was implemented jointly with other teams eg ADHD.

Results 20 children were assessed, age range 6–16 years (mean 9.5), 14 boys, 6 girls. 6 had learning disabilities; all had impaired executive function; 7 had ADHD; 2 had ASD; 3 had affective disorder; 3 had conduct disorder. None had no difficulties and most had multiple difficulties. Additional difficulties below diagnostic threshold were common. They had many additional risk factors for poor outcomes. Carers and professionals found the comprehensive assessment and single formulation very helpful in understanding the child’s needs and planning support and intervention. 3 children were referred for inpatient psychiatric assessment.

Conclusion The children assessed had multiple complex difficulties in educational, social, developmental, emotional, behavioural and psychiatric functioning. Joint assessments and feedback in a ‘community paediatric liaison’ model were feasible, time-efficient and valued highly by families and professionals. Provision of a single comprehensive formulation, explanation of symptoms, and specialist information and advice were particularly valued by those using the service.

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