FASD Assessment

Fetal Alcohol Spectrum Disorder (FASD) is a complex condition that arises from prenatal exposure to alcohol. The condition encompasses a range of physical, neurological, and behavioural difficulties that can have lifelong consequences for affected individuals.

FASD can lead to intellectual disabilities, learning difficulties, poor impulse control, and difficulties with social interactions. It is common in cared for and adopted children and estimated rates lie between 30% and 75% children in these groups are affected.

Understanding the difficulties a child with FASD faces changes the understanding around their behaviour and the support offered. They are no longer considered to be ‘naughty’ and instead recognised as a child struggling and in need of the right support. Getting their educational placement right for them and meeting their sensory needs is often a good place to start.

Guidance for FASD diagnosis

SIGN GUIDELINES AND DIAGNOSTIC CRITERIA WITH NICE QUALITY STANDARDS

The National Institute for Clinical Excellence (NICE) is an independent organisation in the United Kingdom that provides evidence-based guidance and advice to healthcare professionals, policymakers, and the public.
NICE aims to reduce variations in diagnosis and treatment across different regions or institutions.Currently there is NICE quality standard QS204 which covers assessing and diagnosing FASD. It describes high quality care in priority areas for improvement.

The focus on multidisciplinary assessment is important to get a full understanding of a child’s abilities. To do so any existing reports will be taken into consideration and then further assessments may be recommended.

The SIGN guidelines 2019 [SIGN156] for Children and Young People exposed prenatally to alcohol. This guideline provides evidence and consensus based recommendations on the measurement of alcohol consumption in pregnancy, the identification of children at risk and the diagnosis of FASD. It gives specific advice on the assessment and management of children and young people exposed prenatally to alcohol and allows for consistency between clinical services.

To date schools and other NHS services have accepted the private diagnosis made by Dr Sarah Mills because of the clear and thorough reports provided during the assessment.

FASD Assessment Process

Step 1:

Neurodevelopmental Assessment

Information is gathered about the chid, any concerns, past medical history, development and school progress.

Step 2:

Observation and Examination

During the assessment the child’s behaviour will be observed and a short physical examination will be carried out.

Step 3:

Assessments

Recommendations will be made regarding whether further observation and which assessments are needed to understand the child’s neurodevelopemntal profile.

Step 4:

Feedback

Following all of the assessments a feedback session is planned to discuss the findings and further recommendations.

What Happens At an Assessment?

The whole process is child led, your child will be encouraged to share their experiences and participate as much as they wish.

We will talk through concerns, educational progress, medical and family history. Information will be gathered on your Childs development from birth to now and specific symptoms.

Any existing reports or assessments completed on your child are used to inform the process.

The sorts of specific assessments used are:

Home questionnaires on day to day abilities and communication skills
School questionnaires for further information
School observation can be used to gather further evidence of a child’s strengths and areas of difficulty.
Specialist assessments to identify strengths and difficulties across the neurodevelopmental profile are often required to diagnose FASD
The consulting rooms is a relaxing environment that doesn’t feel medical at all.

What Happens After an Assessment?

Following the feedback session, the reports will be compiled and shared with you securely via email.

There is the opportunity to review the report to ensure you are happy with it, it will then be shared with your child’s GP. You are welcome to share the report with nursery, school or other professionals involved in your child’s care.

Included with the final reports is the invoice. This is payable by bank transfer within 28 days. If card payment is preferred this can be arranged and a card link will be sent. All major debit and credit cards are accepted. It is possible to pay by instalments leading up to or following the assessment, please ask for this to be arranged.

There is a post-assessment final discussion included in the assessment fee, this is arranged by video consultation around 8 weeks later. Here any further concerns or questions can be discussed prior to discharge.

FASD Assessment Cost

Developmental Assessment: £325

For children age under 5, this assessment package includes:

Gathering all of the home and nursery based information (where applicable)
Physical examination
Schedule of Growing Skills II developmental assessment
Feedback and recommendations

Additional assessments from allied health professionals like a specialist speech and language therapist, occupational therapist or physiotherapist may be recommended. This can be completed within the NHS or private colleagues.

FASD Assessment: £1,350

For children of school age this assessment package includes:

a neurodevelopmental assessment
gathering all of the home and school based information
specialist additional assessments may be required to look at all elements of the child’s profile including conditions like autism, ADHD and understanding learning and cognition
Feedback

Additional assessments from allied health professionals like a specialist speech and language therapist, occupational therapist or educational psychologist may be recommended. This can be completed within the NHS or private colleagues.

Combined Assessment: £1,850

If you are concerned that autism may be present with other conditions or just aren’t sure it may be worth completing assessments for a range of conditions at the same time.

This package includes:

A neurodevelopmental assessment
Gathering all of the home and school based information
ADOS assessment
ADHD questionnaires
Qbcheck assessment
Feedback

Payment terms: You will receive an invoice with the final reports. This is payable by bank transfer within 28 days. If card payment is preferred this can be arranged and a card link will be sent. All major debit and credit cards are accepted. It is possible to pay by instalments leading up to or following the assessment, please ask for this to be arranged. Dr Sarah Mills is registered with health insurance providers, please contact us to discuss your requirements.

Frequently Asked Questions

There are three main criteria for a diagnosis:
1. pre-natal alcohol exposure,
2. facial aapearance - thin upper lip, small-set eyes, and a smooth space between the upper lip and nose -
3. evidence of significant central nervous system deficits in at least three domains
Community paediatric services, child development centres, and child and adolescent mental health services have training on assessing and diagnosing FASD. They establish multidisciplinary teams and multidisciplinary approaches, with pathways for assessment.
Attention-deficit/hyperactivity disorder (ADHD), intellectual disability (ID), oppositional defiant disorder (ODD), conduct disorder (CD), reactive attachment disorder (RAD), and communication disorders have many common symptoms with FASD.
The similarities in the clinical presentations between FASD and the other diagnoses result in can misdiagnoses and/or missed diagnosis of FASD.

Many affected by FASD do not have any facial features that would suggest the condition.
Characteristic facial features may include a smooth space between upper lip and nose (philtrum), thin upper lip, upturned nose, flat nasal bridge and midface, creases in corners of eyes (epicanthal folds), small eyes, and small head circumference.
Children with FASD may present exactly as any other child. They are more likely to show behaviours like an autistic child or a child with ADHD. FASD commonly presents with concerns about behaviours which may be communications of inner distress, sensory differences or learning difficulties rather than what would be classed as naughty behaviour. Some children struggle to sleep.
FASD is a spectrum disorder and people are affected in many ways. Young people with FASDhave been to university or have successful careers.
Some people with FASD have an IQ within the “normal” range, but are not able to function within the “normal” as they have below average adaptive functioning (day to day skills).