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Clinical Atlas Prestige · Evidence-first

Psych VivasIntellectual disability — neurodevelopmental

Psych Vivas · Intellectual disability — neurodevelopmental

Foetal alcohol spectrum disorder — structured clinical viva

Fellowship viva on FASD criteria frameworks, neurobehaviour, comorbidity care, Streissguth secondary disabilities, and alcohol-free pregnancy prevention.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the dual-diagnosis psychiatry registrar. Kinship carers of a 9-year-old with possible FASD ask: (1) What is FASD and how is it diagnosed? (2) Does he need the facial features for the diagnosis? (3) Is there a medicine that fixes the brain injury? (4) Why is he so impulsive and forgetful if his IQ is average? (5) What will help at school and reduce later trouble with the law? (6) His teenage sister drinks at parties — what should we say about pregnancy? Discuss diagnostic systems, neurobehavioural profile, management, secondary disabilities and prevention.

Interpretation

Reveal interpretation

What is FASD / how diagnosed? Lifelong effects of prenatal alcohol exposure. Multidisciplinary diagnosis using a named framework (Hoyme domains; Cook Canadian with/without sentinel face; Astley 4-digit ranks). Document PAE, growth, face and neurobehavioural impairment — not a single blood test.[1][2]

Must he have the face? No. Sentinel triad (short palpebral fissures, smooth philtrum, thin upper lip) supports FAS-range diagnoses, but FASD without sentinel facial features is valid when PAE and severe brain dysfunction criteria are met.[2][1]

Medicine that fixes injury? No disease-modifying pharmacotherapy for core FASD. Treat comorbidities (ADHD, mood, sleep, substance use) carefully; antipsychotics only for severe behavioural risk after formulation and with monitoring.[4]

Impulsive if IQ average? Classic profile: executive function, attention, memory and adaptive skills often lag what IQ alone suggests — functional impairment is real.[5]

School and later law trouble. Scaffolding, accommodations, carer coaching, multiagency plan. Streissguth: high secondary disability rates; early diagnosis and stable nurturing care protect.[3][4]

Sister and pregnancy. No known safe alcohol amount in pregnancy; support alcohol-free conception/pregnancy; non-judgemental contraception and alcohol help if needed. Quote prevalence order of magnitude if asked (Lange ~7.7/1000 global FASD in children/youth).[4][6]

Name evidence. Hoyme 2016; Cook 2016; Williams AAP 2015; Mattson neurobehaviour; Streissguth 2004; Lange prevalence.[1][2][3][4][5][6]

Key points

Face not mandatory for all FASD

Neurobehaviour + PAE can establish FASD without full sentinel triad under modern systems.

No core FASD tablet

Scaffold environment; treat comorbidities; monitor psychotropics.

Early diagnosis is protective

Streissguth secondary disabilities are preventable targets, not destiny.
[2] [3] [4]

References

  1. [1]Hoyme HE, Kalberg WO, Elliott AJ, et al. Updated Clinical Guidelines for Diagnosing Fetal Alcohol Spectrum Disorders Pediatrics, 2016.PMID 27464676
  2. [2]Cook JL, Green CR, Lilley CM, et al. Fetal alcohol spectrum disorder: a guideline for diagnosis across the lifespan CMAJ, 2016.PMID 26668194
  3. [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. [4]Williams JF, Smith VC; Committee on Substance Abuse Fetal Alcohol Spectrum Disorders Pediatrics, 2015.PMID 26482673
  5. [5]Mattson SN, Bernes GA, Doyle LR Fetal Alcohol Spectrum Disorders: A Review of the Neurobehavioral Deficits Associated With Prenatal Alcohol Exposure Alcohol Clin Exp Res, 2019.PMID 30964197
  6. [6]Lange S, Probst C, Gmel G, Rehm J, Burd L, Popova S Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth: A Systematic Review and Meta-analysis JAMA Pediatr, 2017.PMID 28828483