Fetal Alcohol Spectrum Disorder in Australia: Literature Review
Mothers’ lifestyle choices significantly impact their children both while unborn and later as they grow. Fetal alcohol spectrum disorders (FASDs) include several conditions in the children whose mothers were regular consumers of alcohol during gravidity, including cognitive disabilities, behavioral issues, growth restriction, and craniofacial abnormalities (Cook et al., 2016). Globally, close to one in every ten women (9.8%) drink alcohol during pregnancy (Commonwealth of Australia, 2018; Lange et al., 2017; Popova et al., 2019). The systematic review by Popova et al. (2019) indicates a rising prevalence of FASDs in unique subpopulations, such as the Aborigines of Australia, with significant impairment to children’s memory and executive functions. The current study seeks to address the literature gap concerning elaborate approaches for tackling the neurocognitive and executive functionality issues caused by FASD by imbuing data-driven mechanisms to create a robust FASD strategy. While current literature highlights the estimated pervasiveness of the problem and upcoming initiatives, such as the Commonwealth 2018-2028 FASD strategy, accurate data or findings are absent regarding the populations or communities that are most vulnerable to cognitive disparities, thereby lacking the appropriate evidence-based (EB) approaches to control the condition effectively.
Review of Current Literature
Prevention efforts for cognitive impairments caused by FASD can be implemented effectively using precise prevalence data. Several studies allude to the growing numbers of these cases across Australia, albeit lacking adequate policy measures to control the disorders (Bower & Elliott, 2016; McLean & McDougall, 2014; Popova et al., 2019; Reid, 2018). Popova et al.’s (2018) investigation recorded a 1.5% (14.8 per 1000) incidence rate in Australia, which is significantly lower than in the United States at 14.2% (142.3 per 1000). According to Kodituwakku (2009), studies in the United States have shown that children and adolescents with FASDs have significantly impaired intellectual functionalities, whereby their IQ levels are at low average or borderline ranges. Additionally, FASD patients show slow information processing capabilities combined with low attentiveness, which are often observed from infancy to adulthood. Several studies also report significant executive functioning deficits among FASD children, especially concerning the tasks that involve capturing and interpreting information in the working memory (Bower et al., 2018; Kodituwakku, 2009; Kodituwakku & Kodituwakku, 2014; Khoury et al., 2015; Reid, 2018). Accordingly, cognitive functions, including learning and memory, executive abilities, number processing, and visual perception, record performance diminishment for more complex tasks. Kodituwakku and Kodituwakku (2014) report that FASD children have slow reflective responses and often show associative learning deficits and poor adaptive skills. While these results can be mirrored in Australia to predict cognitive deficits caused by the conditions, actual evidence that frames the Australian populations is still scanty to influence policy prevention and management initiatives.
Most of the available information about the prevalence of FASD cases in Australia, particularly neurocognitive and executive functioning deficits, only covers several remote communities in the nation’s western side, thereby highlighting a wide gap in current literature. Fitzpatrick et al. (2017) recorded among the highest rates of neurodevelopmental disorders and vulnerabilities, including significant cognitive impairments, in the remote communities of Fitzroy Valley, Western Australia, attributed to FASD. Fitzpatrick et al. (2015) indicate the possibility of exacerbations in FASD-related cognitive impairments in the region since over half (55%) of the pregnant women interviewed in the study drank alcohol. Bower et al. (2018) found out that severe neurocognitive impairments, especially executive functioning and memory deficiencies, among youth in a detention facility in Western Australia. Conversely, Bower and Elliott’s (2016) report highlights comprehensive diagnostic strategies for FASD-related memory and executive functioning issues in Australian children and adolescents, but mostly fails to consider populational diversity and environmental factors that could influence the rate of neurocognitive implications caused by FASD among various communities. Therefore, current literature mostly embodies singularized and poorly informed neurocognitive diagnostic approaches to frame Australia’s current FASD situation.
Current data regarding the prevalence of FASD-related neurocognitive deficits in Australia is scanty and corralled into specific but small remote populations in the west. Recently, the Commonwealth Government of Australia developed a long-term FASD strategy to manage the rising cognitive issues associated with FASDs across the nation. However, since present literature and studies derive their outcomes from passive approaches, policy mechanisms developed through the strategy may be significantly ineffective for the wider population. Therefore, decisive management mechanisms must first consider the current information gaps before implementing any policy mechanism. Thus, the current study proposes stratagems that can bridge the existing gaps in the literature for future comprehensive policy frameworks on FASD.
At-risk populations contribute significantly to the rising number of FASD-related executive functioning and memory issues worldwide and in Western Australia. Accordingly, this study proposes a structured roll-out of evidence-based practices fostered through widespread active case research across the nation to augment the current 2018-2028 FASD strategy. The Cognitive theory of psychopathology (or cognitive behavioral theory) states that people’s perceptions and thought processes regarding situations significantly influence their mannerisms or their psychological and emotional outcomes (Karatzias et al., 2016). According to Kadden (1994), this behavioral theory interprets alcoholic dependencies, which are acquired mannerisms, as maladaptive coping approaches with arising issues or social problems. Reid (2018) reports that specific populations, such as incarcerated youths and out-of-home care children, are highly susceptible to adopting alcoholism and other high-risk behaviors, such as indiscriminate sexual encounters, which significantly increases the chances of FASD-related cognitive impairments in future generations. Therefore, all policy mechanisms in the new FASD strategy should consider widespread research within these populations to determine the environmental (mostly social and familial) issues that foster alcoholism amongst pregnant women as a basis of deriving mitigation measures. Furthermore, the strategy should embody EBP methods such as wholistic access to diagnoses, screening, and treatment across all populations; multidisciplinary assessment tactics; health promotion and public awareness; and postpartum support (Poole et al., 2016). These multifaceted approaches will bolster the current efforts to manage FASD-associated neurocognitive conditions across Australia’s populations efficaciously and improve intervention and treatment modalities.
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