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Alcohol consumption during pregnancy and breastfeeding cause adverse health outcomes to the mother and child, including Fetal Alcohol Spectrum Disorder (FASD).Systematic literature review and thematic synthesis. Original studies that contained reasons for alcohol consumption in pregnancy and while breastfeeding were included. The Mixed Methods Appraisal Tool (MMAT) and the Confidence in the Evidence of Reviews of Qualitative Research (CerQUAL) approach were utilised. The review protocol is available on PROSPERO (registration number: CRD42018116998).Forty-two eligible studies comprising women from 16 countries were included. Most commonly reported reasons of alcohol use in pregnancy were societal pressure and the belief that only "strong" alcohol and alcohol in large quantities is harmful. Other reasons were: a lack of awareness of adverse effects on the fetus; coping with adverse life experiences; consumption based on intuitive decision-making and influenced by personal/peer experiences; belief in the beneficial properties of alcohol; advice from medical practitioners; unwanted or unplanned pregnancy; alcohol dependence; and consumption as a cultural/traditional custom. Reasons for alcohol use during breastfeeding included the belief that alcohol stimulates breast milk production, unclear advice from medical practitioners, unawareness of the risks of infant exposure and to improve mood and celebrate events.Understanding the context of reasons for alcohol use in pregnancy is crucial for implementing prenatal health education, and preventing FASD and other adverse maternal and child health outcomes.Individual beliefs, knowledge/advice, culture and personal circumstances influence alcohol use in pregnancy. Data are limited for reasons surrounding alcohol use while breastfeeding.

Early diagnosis of Fetal Alcohol Spectrum Disorder (FASD) is known to improve outcomes in children. It is less clear if diagnosis in adulthood also conveys benefits. This study investigated long-te...

Objective: To compare the characteristics of mothers of children with Fetal Alcohol Spectrum Disorder (FASD) with mothers of typically developing control children. Methods: The study utilized a cross-sectional, observational design, using active case ascertainment. Biological mothers were interviewed using a standardized retrospective questionnaire to collect data on demographics, living environment, pregnancy history, nutrition, alcohol and other drug use prior to and following pregnancy recognition. Results: A total of 173 mothers were interviewed. Of these, 19 had a child who was diagnosed with FASD, five had a child who had received a deferred FASD diagnosis, and 37 had children who were selected into the control group as typically developing children. The remaining 112 mothers had children who did not meet diagnostic criteria for FASD. The mothers of children with FASD did not differ significantly from mothers of the control group children with respect to age, ethnicity, marital status, and employment status at the time of pregnancy. However, mothers of children with FASD had lower levels of education (p &lt, 0.01) and were more likely to have received financial support (p &lt, 0.05) at the time of pregnancy, to have smoked tobacco (p &lt, 0.001), and to have used marijuana or hashish (p &lt, 0.01) prior to pregnancy recognition, compared with mothers of control children. All mothers of children with FASD reported alcohol consumption prior to pregnancy recognition, however, only 10.5% reported alcohol consumption following pregnancy recognition. None of the mothers interviewed reported any drug use following pregnancy recognition. Conclusions: Population-based preventive interventions, including repeated screening, monitoring, and education regarding the effects of alcohol use, as well as other substances, before and during pregnancy, are needed to eliminate risk for FASD and other negative consequences on child and maternal health.

Background Fetal Alcohol Spectrum Disorder (FASD) is a leading cause of lifelong developmental and physical disabilities and behavioural problems. This study describes the characteristics of individuals diagnosed with or at risk for FASD in British Columbia, Canada. Methods A retrospective chart review and cross-sectional analysis were conducted on records of individuals diagnosed or at risk for FASD at the Asante Centre from January 2015 to July 2019. Descriptive statistics results were stratified by age, sex, and involvement with the criminal justice and child welfare systems. Logistic regression was used to investigate potential associations. Results 161 individuals with diagnosed or at risk for FASD, (53 % male; mean age = 15.7 years, SD = 9.1) were included in the analysis. High levels of psychological/developmental disabilities (78 %), physical comorbidities (38 %), substance use (50 %), and involvement in child welfare (75 %) and criminal justice systems (30 %) were found across the entire group. Individuals over 20 reported the greatest proportion of any past substance (60.9 %), alcohol use (39.1 %) and stimulant use (30.4 %), compared to individuals aged 10–19 (41.3 %; 12.0 %; 14.1 %, respectively). Involvement with the child welfare system was associated with higher chances of having anxiety (OR 4.1; 95 % CI: 1.25–15.00). Involvement with the criminal justice system was associated with higher rates of past substance and cannabis use. Conclusion Individuals with FASD demonstrate a significant need for access to mental health and addiction services, especially among those with involvement in the child welfare and criminal justice systems. These findings point to the importance of improving policies to support the unique needs of individuals with FASD.

Background. Individuals with fetal alcohol spectrum disorder (FASD) experience a range of problems in their cognitive, affective, and physical functioning following prenatal alcohol exposure (PAE), in addition to multiple complex difficulties in daily living that impact well-being. Using the Canadian National FASD Database, we sought to profile a range of difficulties in daily living, along with risk factors, in a large cross-sectional cohort of adolescents, transition-aged youth, and adults with PAE, of which a subset was ultimately diagnosed with FASD. Methods. We summarized data for 9 current difficulties in daily living reported at the time of diagnostic assessment for 726 individuals with PAE assessed at 26 FASD diagnostic clinics across Canada, including 443 adolescents (12 to 17 years), 135 transition-aged youth (18 to 24 years), and 148 adults (25 to 60 years). Difficulties included problems related to school disruption, employment, independent living needs, supportive or sheltered housing, legal problems with victimization, legal problems with offending, incarceration, alcohol misuse, and other substance misuse. Risk factors included age, gender, living placement, postnatal trauma, and neurodevelopmental impairment. Results. Across the full PAE sample, adolescents, transition-aged youth, and adults presented with high rates of difficulties in daily living, including independent living support needs (63%), alcohol misuse (38%), other substance misuse (46%), employment problems (37%), legal problems with offending (30%), assisted or sheltered housing (21%), school disruption (18%), legal problems with victimization (4%), and incarceration (3%). Difficulty rates were similar for those with FASD irrespective of diagnosis (e.g., with or without sentinel facial features), but rates greater for adults, and those with low overall intellectual functioning (IQ < 70). Controlling for age and IQ, cumulative difficulty was independently associated with gender, living placement, and neurodevelopmental impairment. Conclusions. Adolescents, transition-aged youth, and adults with FASD experienced a range of substantial and complex difficulties at the time of their diagnostic assessment, signaling a high level of service needs. These findings underscore the importance of developmentally informed assessment continued through childhood, as well as ongoing functional and needs-based service provision as youth with FASD transition to adulthood and beyond. Kids Brain Health Network; Canada FASD Research Network 2021-05-29

AimsIndividuals with fetal alcohol spectrum disorder (FASD) frequently have challenges with regulating emotional arousal, or affect regulation (AR), and experience high rates of mental health disorders. This study examined children and adults with FASD to investigate the relationship between AR impairment and several mental health problems and diagnoses.MethodsData from the Canadian national FASD database was used for analysis. Seven mental health diagnoses, including attention-deficit/hyperactivity disorder, post-traumatic stress disorder, conduct disorder, attachment disorder, intellectual disability, and language disorder were examined. A history of suicidality was also examined. The prevalence of these mental health problems in individuals with and without AR impairment was compared.ResultsIndividuals with FASD and AR impairment were significantly more likely to be diagnosed with conduct disorder (OR 4.8), attachment disorder (OR 6.1), or post-traumatic stress disorder (OR 8.1) when compared to those without AR impairment. They were also more likely to have a history of suicidality (OR 8.6). AR impairment was most commonly found in those with greater overall neurodevelopmental impairment. Having AR impairment was associated with receiving a diagnosis of FASD at a later age, but was not related to gender, intellectual disability, or language disorder.ConclusionAR impairment is strongly related to several mental health diagnoses in those with FASD and presents some promising possibilities for targeted early intervention.

Background: Interpreting cognitive assessment results for individuals from indigenous communities can be complex. Factors such as culture, language, and education may influence results. Alt...

Background Video conferencing (VC) technology has great potential to increase accessibility to healthcare services for those living in rural or underserved communities. Previous studies have had some success in validating a small number of psychological tests for VC administration; however, VC has not been investigated for use with persons with intellectual disabilities (ID). A comparison of test results for two well known and widely used assessment instruments was undertaken to establish if scores for VC administration would differ significantly from in-person assessments. Method Nineteen individuals with ID aged 23–63 were assessed once in-person and once over VC using the Wechsler Abbreviated Scale of Intelligence (WASI) and the Beery-Buktenica Test of Visual-Motor Integration (VMI). Results Highly similar results were found for test scores. Full-scale IQ on the WASI and standard scores for the VMI were found to be very stable across the two administration conditions, with a mean difference of less than one IQ point/standard score. Conclusion Video conferencing administration does not appear to alter test results significantly for overall score on a brief intelligence test or a test of visual-motor integration.

The consequences of prenatal alcohol exposure were first described more than 40 years ago.[1][1],[2][2] The term “fetal alcohol syndrome” (FAS) was first used to describe the cluster of birth defects due to prenatal alcohol exposure (including growth restriction, craniofacial abnormalities and

Les aines constituent le groupe le plus important d'utilisateurs de fauteuils roulants. Cependant, il n'existe a ce jour aucune etude revisee par des pairs qui dresse un profil national des aines qui se servent de fauteuils roulants au Canada. Nous avons etudie les caracteristiques d'utilisateurs de fauteuils roulants provenant d'un echantillon national d'aines vivant dans la collectivite tire de l'e tude sur la sante et le vieillissement au Canada (ESVC-2). Des questions sur l'utilisation des aides fonctionnelles ont ete posees a 5 395 Canadiens (âges de 65 ans et plus) et 4,6 p. 100 d'entre eux ont declare utiliser un fauteuil roulant. Un modele de regression logistique a ete utilise pour representer les facteurs lies a l'utilisation d'un fauteuil roulant. Si l'on tient compte de l'âge, du sexe et des troubles cognitifs, on constate que les aines qui ont declare dependre davantage des soins personnels de base et des activites instrumentales de la vie quotidienne ont davantage de chances d'utiliser un fauteuil roulant. Cependant, l'incidence de la dependance aux soins personnels sur l'utilisation d'un fauteuil roulant varie selon le sexe, les hommes ayant davantage tendance que les femmes a utiliser un fauteuil roulant lorsque leur dependance aux soins personnels augmente. La quantite de problemes de sante chroniques ainsi que le celibat ont egalement tendance a accroitre la probabilite d'utiliser un fauteuil roulant. Cet article quantifie les chances d'utiliser un fauteuil roulant en fonction de facteurs critiques dont on peut se servir pour prevoir et pour planifier les services necessaires. The behavioural and emotional changes associated with Alzheimer's disease (AD) are compared for individuals with Down syndrome and AD and individuals with AD from the general population (AD-only). The primary caregivers of 30 people with Down syndrome and AD and 30 people with AD-only completed the BEHAVE-AD and the Apathy subscale of the CERAD. As well, behavioural observations at adult day programs were undertaken with selected participants (n = 26). The Down syndrome group experienced fewer delusions and had lower total scores on the BEHAVE-AD, indicating fewer problem behaviours overall. Day program observations suggested that the AD-only group were more likely to be sedentary and observe the activities of others, while the Down syndrome group were more physically active. Improving our understanding of the similarities and differences between these two groups may help facilitate the integration of individuals with Down syndrome into adult day programs for the general population.

Background Individuals with intellectual disabilities respond to loss in similar ways to other individuals. Bereavement interventions, whether provided individually or in a group, need to be planned according to the person’s understanding, presenting symptoms, psychological functioning and support system. Measuring the effectiveness of such interventions is critical in order to increase our knowledge of useful interventions for this population. The present authors discuss individual and group bereavement therapy, and outline the goals and approaches used in their bereavement groups for adults with intellectual disabilities. Methods Individuals referred for bereavement group therapy were interviewed and assessed prior to their participation in the group. Measures of depression, anxiety, and knowledge of death and bereavement issues were administered before and after group participation. Results Scores for depression were significantly lower following group participation. However, scores for anxiety were mild and not significantly reduced. The participants’ understanding and knowledge of the bereavement process did not improve significantly. When those with single and dual diagnosis were considered separately, those with a dual diagnosis experienced a significant decrease in depression, while those with a single diagnosis did not. Furthermore, depression scores for those with a dual diagnosis were generally higher. Conclusions The present preliminary investigation of therapeutic outcomes for bereavement group intervention suggests little change in anxiety and knowledge of death/bereavement issues, but significant improvement in symptoms of depression for participants, particularly those with a dual diagnosis. The weaknesses of the present study are discussed along with possible improvements for future studies.

Although the clinical literature reports that psychotherapists have increasingly used brief solution-focussed therapy with a variety of populations, there is no mention of the use of this model with adults who have a developmental delay. This descriptive paper discusses a modified brief solution focussed approach with clients at Surrey Place Centre and the authors' initial attempts to evaluate it. We found that our modified approach was most successful for those who were higher functioning, were self-referred, and were supported in the therapeutic process by others. Those clients with fewer presenting problems and whose problems were related to self-esteem, family, and loss also fared better overall, according to clinician ratings. Our brief therapy service was delivered in less time (mean 118 days) than service to our clients in long-term psychotherapy (mean 372 days) (p < .001), with less of a waiting period for service. Clients and their caregivers were satisfied with the service as reported i...

More years of education have been found to be associated with a lower rate of Alzheimer disease (AD) in individuals without intellectual disability. It has been proposed that education reflects greater 'synaptic reserve' and that greater synaptic reserve may defer the development of AD. The present study compared individuals with Down's syndrome (DS) who were found to have symptoms of dementia with those who remained symptom-free to determine if the two groups differed in their level of education, employment, recreational activities, years in an institution or overall level of cognitive functioning. Thirty-five adults with DS aged between 29 and 67 years were assessed. The participants were recruited from a community health facility and included individuals with a wide range of ability levels. Neuropsychological testing, caregiver report and the Dementia Scale for Down Syndrome (Gedye 1995) were used to identify decline in participants over periods of 6 months to 3 years. After the effect of age was statistically removed, multiple regression analyses revealed that level of cognitive functioning was significantly associated with decline such that a higher level of cognitive functioning predicted less decline. None of the environmental variables (i.e. educational level, years in an institution and employment) were directly associated with decline; however, a post hoc regression using level of cognitive functioning as the outcome variable revealed that level of cognitive functioning itself was associated with these environmental variables. A higher level of cognitive functioning was associated with fewer cases of dementia in individuals with DS, and level of cognitive functioning appears to be associated with environmental factors such as level of education, years in an institution and employment. The present findings suggest that environmental interventions aimed at improving level of cognitive functioning may also be useful in deferring the onset of dementia.

RÉSUMÉOn a effectué un sondage des prestateurs de services pour déterminer les enjeux de la prestation de services aux adultes vieillissant souffrant de troubles de développement. On a fait parvenir 75 questionnaires à 38 organismes s'occupant de soutien aux aîné(e)s souffrant ou non de troubles de développement. Quarante-quatre, soit 59 pour cent des questionnaires, ont été retournés. Les résultats laissent entendre que les prestateurs de services ne se sentent pas bien formés pour répondre à plusieurs des besoins des adultes vieillissant souffrant de troubles de développement. Les personnes ayant répondu au questionnaire ont demandé de la formation supplémentaire pour s'occuper de certains aspects des soins, notamment la santé et les inquiétudes médicales des adultes vieillissant souffrant de troubles de développement ainsi que pour la planification de leurs loisirs et de leur retraite. Ils ont également demandé de l'aide de professionnels, par exemple des psychologues et du personnel médical, connaissant la population dont ils s'occupent. Les résultats se rapprochaient de ceux de sondages précédents faisant ressortir l'importance de la formation des soignants et de l'appui médical. Les renseignements recueillis mettent à jour et étendent nos connaissances des besoins de ceux qui se consacrent au service des aîné(e)s vieillissant(e)s souffrant de troubles de développement au Canada et fournissent des détails sur les types de données et de soutien nécessaires. Le document présente également des recommandations préliminaires sur la modification de la prestation des services, sur les politiques et sur les programmes éducatifs.