Therapeutic Recommendations in the Youth Justice System Cohort Diagnosed with Foetal Alcohol Spectrum Disorder

Abstract

Patches Paediatrics is a specialised private multidisciplinary service in Western Australia (WA), offering a range of developmental diagnostic assessments such as foetal alcohol spectrum disorder (FASD). Many FASD assessments occur in children and youth who are engaged with the justice system in WA and the Northern Territory (NT). There are currently no studies outlining the types of clinical recommendations and management strategies made or implemented by clinicians for this clinical population within Australia. This study outlines therapeutic recommendations made as part of the youth justice FASD diagnostic process within Patches Paediatrics to ultimately refine recommendations to inform therapeutic strategies. This was a retrospective cross-sectional descriptive study of those aged 10 years to 17 years 11 months (N = 64) who were diagnosed with FASD within Patches Paediatrics; and referred from the youth justice system in WA and the NT between January 2017 and February 2019. Information on FASD recommendations was gathered by reviewing participants’ source documents, such as FASD diagnostic reports. ‘FASD recommendations’ categories were divided into subdomains: medical, mental health, developmental, lifestyle, future goals and others. In the various categories of recommendations, the most prominent were referral for National Disability Insurance Scheme (NDIS) funding (75%) followed by education support (67.2%), occupational therapy (56.3%), and drug and alcohol services (45.3%). Significant correlations between impaired neurocognitive domains and recommendations were also observed. Similarly, there were significant correlations between comorbidities and recommendations. Our study highlighted gaps in recommendations for those with comorbid attention-deficit/hyperactivity disorder (ADHD), rural communities and access to NDIS, therapeutic rehabilitation programmes as well as community work programmes. Other gaps included making adequate recommendations for speech/language therapy, education support, life skills advice and staff/clinician education. This study was the first to describe therapeutic recommendations for the youth cohort assessed by Patches Paediatrics in WA and the NT. It also showed significant correlations between the neurocognitive/comorbidity profile and clinical recommendations. This highlights areas within the recommendations that can be individualised as well as ways to improve community integration. A discussion of limitations and suggestions for future research is also provided.