mai nei kei te kōpū womb i te huaki pouri on the edge of
TRANSCRIPT
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.