Psych CASC / OSCE · Intellectual disability — neurodevelopmental
Explain FASD diagnosis and supports to kinship carers — CASC communication station
MRCPsych/FRANZCP-style communication station: explain FASD without mother-blame, face-not-always-required concept, no disease-modifying drug, scaffolding and comorbidity care, secondary disability prevention hope, and alcohol-free pregnancy messaging.
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Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the dual-diagnosis / CAMHS psychiatry registrar. [1]
Candidate instructions. Explain the FASD diagnosis to kinship carers in plain language, address whether facial features are required, clarify that no medicine cures the brain injury, outline school and home supports, give hope through early diagnosis and structure, and answer a question about alcohol and pregnancy for a teenage relative. The examiner plays the carers. [1][2]
Candidate scenario
Your patient, age 9, has multidisciplinary confirmation of FASD after documented prenatal alcohol exposure, learning and executive difficulties, and partial facial features. Carers ask: "Is this our fault for taking him in? Will tablets make him normal? Does he have autism? His cousin drinks at parties — how much is safe if she gets pregnant?" [1][4]
Marking domains
- Empathy, structure, agenda-setting; avoid mother-blame and carer-blame
- Accurate plain-language explanation of PAE-related brain and behaviour effects (spectrum)
- Clear statement that facial features help but are not always required
- No disease-modifying drug; supports + treat ADHD/mood/sleep if needed
- School scaffolding and multiagency plan; early diagnosis reduces secondary problems
- Prevention message: no known safe alcohol in pregnancy
- Checks understanding; offers written information and follow-up [1][2][3]
Reveal assessor key
Open. Thank them; name the time; ask main worries first. Affirm that kinship care is protective; FASD is caused by alcohol exposure before birth, not by their current parenting alone.[1]
Explain FASD. "FASD means the developing brain was affected by alcohol during pregnancy. It can affect attention, memory, planning and everyday skills. It is a spectrum — needs vary. Some children have facial clues; many do not need the full face pattern for the diagnosis when exposure and brain effects are clear."[2][4]
Medicines. "There is no tablet that removes FASD. If he also meets criteria for ADHD or other problems, medicines may help those parts, with careful monitoring. The main treatment is structure, school adjustments, and teaching skills step by step."[1]
Hope and secondary outcomes. Early accurate diagnosis and stable caring homes improve chances of better school and life outcomes; we plan supports now to reduce later risks.[3]
Pregnancy prevention message. "For anyone who might become pregnant: there is no known safe amount of alcohol in pregnancy. Stopping alcohol when planning a pregnancy or as soon as pregnancy is recognised is the safest advice. We can help with confidential advice and support if drinking is hard to stop."[1]
Close. Summarise, invite questions, crisis contacts if aggression escalates, written leaflet, review date with school liaison. [1]
References
- [1]Williams JF, Smith VC; Committee on Substance Abuse Fetal Alcohol Spectrum Disorders Pediatrics, 2015.PMID 26482673
- [2]Hoyme HE, Kalberg WO, Elliott AJ, et al. Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders Pediatrics, 2016.PMID 27464676
- [3]Streissguth AP, Bookstein FL, Barr HM, Sampson PD, O'Malley K, Young JK Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects J Dev Behav Pediatr, 2004.PMID 15308923
- [4]Cook JL, Green CR, Lilley CM, et al. Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan CMAJ, 2016.PMID 26668194