He mokopuna He taonga A child, a treasure

Ko taku tamaiti e noho

mai nei kei te kōpū

My child who lies within the

womb

I te huaki pouri On the edge of darkness,

come forth

Nau mai, haere mai Come forth into the world

He wahine, he whenua,

ka ngaro ai te tangata

Women and land both

provide sustenance and

nourishment and without

them the myriads of

descendants are lost

Hawke’s Bay Experience:

From Clinical to PhD

“Social cognition, executive functioning and IQ: What are the important influences on adaptive functioning in children with FASD?”

Andi Crawford

FASD Sig Day, Paediatric Society Conference

6th November 2018

Fetal Alcohol Spectrum Disorder (FASD)

Prenatal alcohol exposure damages the developing

brain.

Children with FASD have significant learning problems.

Complicated by additional impairments.

Inattention and impulsivity.

Communication issues.

Memory.

Recognising emotions and theory of mind.

Emotional dysregulation.

Background:

Individuals with FASD require life long support.

Adaptive functioning difficulties remain after

accounting for IQ.

Executive functioning.

Social cognition.

Context is also important.

Adverse Childhood Experiences.

Partnership with Te Wāhanga Hauora Māori

Planning

Ethics

Gathering Consent

Data Collection

Analysis and Interpretation

Dissemination of Findings

Context of Aotearoa is important

Pre-colonisation.

Colonisation.

Indigenous FASD prevalence is associated with

historical and current trauma.

Cultural Renaissance.

Te Whare Tapa Whā (Durie, 1994)

Taha Tinana -

Physical well-being

Taha wairua –

Spiritual well-being

Taha hinengaro –

Mental and emotional well-being Taha whānau –Family & social well-being

Hypothesis: What do I expect to find?

Executive functioning

IQ

Social thinking

Adverse Childhood Experiences

Adaptive

Functioning

(Life Skills)

Home and

School

Method: Participants

Variable FASD Group

N=39

Comparison

N= 29

Age (years), M (SD) 9.51(1.12) 9.65 (1.12)

Gender (% male) 77% 69%

No Secondary Quals 72%* 38%*

No Tertiary Quals 80% 79%

Dep Index 7 - 8

Dep Index 9 - 10

15%

59%

41%

41%

Ethnicity

Māori

Pākehā

Pacific Nation

82%

15%

3%

72%

17%

10%

Method: Measures

Prenatal Alcohol Exposure Data.

Neuropsychological Data.

Demographic and historical data including

Adverse Childhood Experiences.

Prenatal alcohol exposure – FASD Group

0

10

20

30

40

50

60

70

80

90

100

40+ 20-39 7-19 2 0

Pe

rce

nti

le

No. of standard drinks per week

1st Trimes 2nd - 3rd Trimes

0

10

20

30

40

50

60

70

80

90

100

40+ 20-39 7-19 1 0

Pe

rce

nti

le

No. of standard drinks per week

1st Trimes 2nd - 3rd Trimes

Prenatal alcohol exposure –Comparison Group

Measures Domain FASD Comparison

General Intellectual

Functioning

WISC-IV WASI-II

Executive

functioning

NEPSY-II: Animal Sorting and Inhibition

D-Kefs: Tower test

Communication CELF-4 CELF-Screener

Social Cognition TOPS-3

SCST

DANVA: Facial Recognition

Adaptive

Functioning

Vineland II: Parent

and Teacher

Vineland II: Parent

Psychosocial factors – FASD Group

Strengths/Resilience

Children living with whānau

Connected to marae

Identification of strengths

Challenges

Multiple placements

Parental learning difficulties

High Adverse Childhood

Experiences score

Domicile in high deprivation

areas

Results: Between group analysis

The comparison group scored significantly

higher (p-values < .001) than the FASD group on all measures of:

Social cognition.

General intellectual functioning.

Executive functioning.

Adaptive functioning.

Results: Correlational Analysis

FASD Group Comparison Group

Adaptive functioning (Parent rated)

IQ 0.32t 0.34t

Executive

Functioning

0.33* 0.05

Social Cognition 0.19 0.30

Adverse Childhood

Experiences

-0.30t

t p < .10, * p <.05

Results: Correlational Analysis

FASD Group Comparison Group

Adaptive functioning (Parent rated)

IQ 0.32t 0.34t

Executive

Functioning

0.33* 0.05

Social Cognition 0.19 0.30

Adverse Childhood

Experiences

-0.30t

t p < .10, * p <.05

Results: Correlational Analysis

FASD Group Comparison Group

Adaptive functioning (Parent rated)

IQ 0.32t 0.34t

Executive

Functioning

0.33* 0.05

Social Cognition 0.19 0.30

Adverse Childhood

Experiences

-0.30t

t p < .10, * p <.05

Results: Correlational Analysis

FASD Group

Adaptive Functioning

(Parent)

Adaptive Functioning

(Teacher)

IQ 0.32t .46**

Executive

Functioning

0.33* .34*

Social Cognition 0.19 .62***

Adverse Childhood

Experiences

-0.30t -.37*

t p < .10, * p <.05, ** p <.01, *** p < .001

Results: Correlational Analysis

FASD Group

Adaptive Functioning

(Parent)

Adaptive Functioning

(Teacher)

IQ 0.32t .46**

Executive

Functioning

0.33* .34*

Social Cognition 0.19 .62***

Adverse Childhood

Experiences

-0.30t -.37*

t p < .10, * p <.05, ** p <.01, *** p < .001

Results: Regression Analysis – FASD Group

Teacher

rated

Adaptive

Functioning

IQ

Executive Functioning

Social Cognition

Results: Regression Analysis – FASD Group

Teacher

rated

Adaptive

Functioning

IQ

Executive Functioning

Social Cognition

R² = 0.43 (F (3,32) = 7.89, p < .001)

Results: Regression Analysis – FASD Group

Predicting teacher-rated adaptive functioning.

Predictor variables Std

𝜷t p

(Constant) 4.95 .000

IQ 0.25 1.42 .17

Executive functioning -0.10 -0.54 .59

Social Cognition 0.55 3.42 .002

R² = 0.43 (F (3,32) = 7.89, p < .001)

Results: Regression Analysis – FASD Group

Teacher

rated

Adaptive

Functioning

Social Thinking

TOPs

SCST

Recognising emotions

(Adult faces)

Results: Regression Analysis – FASD Group

Teacher

rated

Adaptive

Functioning

Social Thinking

TOPs

SCST

Recognising emotions

(Adult faces)

R² = 0.38, (F (3,32) = 6.49, p = .001)

Results: Regression Analysis – FASD Group

Predicting teacher-rated adaptive functioning.

Predictor

variables

Std

𝜷t p

(Constant) 6.62 0.000

TOPS-3 0.18 1.12 .27

SCST 0.20 1.26 .22

DANVA-

adult faces

.42 2.84 .008

R² = 0.38, (F (3,32) = 6.49, p = .001)

Main findings:

Children with FASD experience significant learning

and behaviour difficulties, often in the context of

psychosocial complexity.

Main findings:

Children with FASD experience significant learning

and behaviour difficulties, often in the context of

psychosocial complexity.

Impairments in social and emotional cognition

(especially recognising emotions on adults faces)

appear to be the most important influence on

adaptive functioning.

Main findings:

Children with FASD experience significant learning

and behaviour difficulties, often in the context of

psychosocial complexity.

Impairments in social and emotional cognition

(especially recognising emotions on adults faces)

appear to be the most important influence on

adaptive functioning.

Challenges in all of the pillars of Te Whare Tapa

Whā.

Recognising Emotions

First stage of social information processing.

May affect relationship with the adults in their

life e.g. teachers

Those that need increased support may be less

likely to receive it because they are not

connected to their teachers.

The importance of a secure relationship.

Social thinking is especially important

in Te Ao Māori.

Society is organised by whakapapa.

Connectedness vital for passing down values and

beliefs.

Tikanga required high levels of social and emotional

competence.

Whakawhanaungatanga is essential in creating a

secure identity.

Whakawhanaungatanga helps us advocate for

ourselves.

But do services meet the need?

Disability Services?

39% meet criteria for

Intellectual Disability

Mental Health

Services?

5-8% meet criteria

for Depression &

Anxiety

Non-government

organisations

BUT

can be limited in

resource and are

overwhelmed

And all systems focus on the individual child…..

Historical Trauma & Institutional Racism

Historical trauma

affects communities

through

Individual impacts

Intergenerational impacts

Bio/psycho/social

Institutionalised Racism – When systems are set up to meet the needs

of the dominant race whilst penalising minority groups.

Creating a dominant

social structural system

(Rangihau et al, 1988)

Service Delivery and Interventions:

The way services are contracted must replicate

what we are expected to do in clinical and

cultural practice.

Taha Tinana - Physical well-beingTaha wairua - Spiritual well-being

Taha hinengaro - Mental

and emotional well-being

Taha whānau - Family & social well-being

Service Delivery and Interventions

Focus on the child.

Focus on the whānau.

Increase cultural responsivity of clinicians and

professionals.

Systems need to address the psychosocial

complexity.

Service Delivery and Interventions:

Cultural Responsivity

For Māori relationship and connectedness

form the basis of society and infrastructure.

Security, belonging, identity and

involvement.

Connectedness within holistic Māori models.

But nothing should be done without

partnership….

Local Hawke’s Bay work

FASD diagnosis and assessment pathway.

Education modules for all agencies and community.

Training with Iwi providers

Hawke’s bay FASD action plan.

Post diagnosis co-ordinator.

New Parenting and pregnancy addiction service –Te

Ara Manapou.