FASD and Mental Health for Professionals

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Happy Mental Health Week! Today we’re looking at mental health and fetal alcohol spectrum disorder (FASD) from the point of view of health professionals.

It is estimated that 4% of Canadians have FASD. This is a lifelong disability that impacts the brain and body of people exposed to alcohol during fetal development. But we also know that targeted supports and services can help improve outcomes for individuals with FASD.

One in five Canadians experience challenges with mental health. This proportion is high, but the stats are even higher for individuals with FASD. Researchers have shown that approximately 90% of people with FASD experience mental health issues. These numbers show that mental health is an extremely important consideration when discussing needs, supports, and resources for individuals with FASD. At times it can be difficult to serve individuals with FASD because they often live with many overlapping challenges and complicated environmental situations. These issues can lead to frustration for both the individual with FASD and their mental health care provider. 

So how can mental health professionals better support individuals with FASD in their practice?

Increase their knowledge and understanding of FASD

FASD is still a relatively new diagnosis that many Canadians are unfamiliar with. Health and social service professionals often aren’t given adequate training on FASD, despite it being one of the most prevalent developmental disabilities in Canada. Training programs for mental health professionals need to make sure that they provide specific information and strategies on how to best support individuals with FASD. In the meantime, professionals should seek opportunities for further training and professional development to ensure they have the knowledge to best recognize, treat, and support people with FASD.

Recognize the signs of FASD

FASD is often undiagnosed or misdiagnosed because symptoms can be hard to recognize, and diagnostic services are limited. With many individuals with FASD coming into contact with mental health services, mental health professionals are in a prime position to kickstart the diagnostic process. These professionals should have a strong understanding of the range of potential cognitive, socioemotional, and adaptive impairments that are common for individuals with FASD in order to recognize these signs and to refer for assessment when appropriate.

Find ways to communicate effectively

When recommending treatments, mental health professionals should be aware that individuals with FASD may have difficulty understanding information, following directions, and applying information they have learned into real-world scenarios. However, there are a number of ways professionals could potentially overcome these challenges, including: 

  • Speaking in specific, concrete language
  • Slowing down the pace of conversation
  • Using role-plays and other forms of communication when possible
  • Limiting the use of colloquialisms and idioms to avoid confusion
  • Using clear, direct statements
  • Breaking down complex directions into one step at a time
  • Using repetition to ensure the client has retained the information provided
  • Ensuring consistency in how the information is presented (i.e., language use, tone, subject matter)

Identify functional needs and strengths 

Many individuals with FASD experience challenges with executive functioning, adaptive behaviour, memory, and communication that may limit their ability to navigate daily activities. These difficulties can play out differently depending on the individual, so there is no one treatment plan that will work to support everyone with FASD. Mental health professionals should take an individualized approach to assess an individual’s strengths and challenges in order to develop an effective treatment plan.

Adapt treatments and interventions

FASD as an extremely unique disability. The range of potential challenges is very broad, and individuals with FASD may also have complex comorbid mental and physical health challenges. As a result, traditional therapeutic approaches that address mental health difficulties may not be very effective for people with FASD if they are not adapted appropriately. Therefore, mental health professionals need to take an FASD diagnosis into consideration when developing treatment plans.

Provide holistic support

As a result of the complex needs that many people with FASD experience, comprehensive and holistic approaches to mental health treatment are warranted. Some of the most helpful programs for individuals with FASD may involve skill building, modelling, and coaching approaches. Successful treatments might also include one or more of the following:

  • Structured inpatient settings or outpatient settings that are FASD-informed
  • Trauma and attachment-informed therapeutic approaches
  • Stress reduction techniques
  • Developmentally appropriate interventions (i.e., play therapy or art therapy)
  • Sexual education
  • Substance use education and interventions
  • Safety education
  • Sleep improvement techniques
  • Developing social, emotional, and behavioural regulation skills
  • Accounting for sensory processing issues
  • Practicing in stable environments with minimal change
  • Providing resources to improve a client’s organizational and time management skills

Many of these approaches will require cross-disciplinary collaboration and coordination with other service providers, so it is recommended that mental health professionals familiarize themselves with FASD-specific resources and services in their areas. 

Due to the cognitive and social difficulties experienced by many people with FASD, the following treatments may be less successful if they aren’t modified appropriately:  

  • Treatments where higher-level cognitive skills (i.e., the ability to plan and organize) are important for success
  • Traditional psychotherapy
  • Cognitive-based therapy
  • Insight-based therapy
  • Outpatient settings that lack an understanding of FASD
  • Group therapy
  • 12-step programs

Involve the individual’s support system

For individuals with FASD, consistency between therapeutic settings and their daily lives can support them in generalizing and applying new skills. Mental health professionals should work with members of the individual’s social support system to give friends and family tools to help ensure this consistency in the individual’s daily life. In practice, this might involve reminders – like hand gestures or verbal cues – that prompt the individual to remember and apply healthy coping techniques that they have learned in treatment.

Mental health professionals should always:

  • Remain patient, as the treatment process can be challenging for both the client and the service provider
  • Allow plenty of time for the client to respond to questions and complete tasks
  • Focus on building on strengths and minimizing the impact of challenges rather than on “curing” the individual
  • Adjust the expectations and definition of “success” for each client
  • Cooperate and collaborate with other professionals and caregivers involved in the individual’s life to ensure their diverse needs are met
  • Recognize that individuals with FASD may require ongoing treatment and support even after treatment has been completed 

For more information check out the following articles:
Recent advances in fetal alcohol spectrum disorder for mental health professionals
Fetal alcohol spectrum disorder (FASD): A beginner’s guide for mental health professionals
Intervention for individuals with fetal alcohol spectrum disorder: treatment approaches and case management
Mental health issues in fetal alcohol spectrum disorder

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