Fetal alcohol spectrum disorder diagnosis and intervention: An investigation of professional practice in New Zealand

Abstract

Fetal alcohol spectrum disorder (FASD) is an umbrella term used to describe a range of neurodevelopmental and physical impairments associated with prenatal alcohol exposure. It is a brain-based disability which manifests in behavioural symptoms and cognitive deficits that adversely impact on the affected individual and their family. While FASD has been acknowledged as a disorder since the 1970s, it remains poorly understood in the New Zealand context, and does not attract much support from health and allied health services. Meanwhile, the normalization of alcohol in New Zealand culture affects the ways in which FASD is approached and perceived by medical specialists and lay people alike. This thesis investigates the ways in which professionals within health, allied health and social service systems in New Zealand encounter, approach and manage FASD and cases of suspected FASD. It examines the circumstances surrounding diagnosis of and intervention for FASD in New Zealand, and the factors that inform professional practice in these two fields. It questions how FASD fits within specific professional practice contexts, how social and cultural forces influence the actions of professionals, and what barriers may exist in FASD-related practice. It aims to provide a nuanced analysis of how FASD is currently handled, and suggests potential strategies for achieving more effective service provision for FASD. The research presented in this thesis is theoretically and methodologically grounded in applied medical anthropology, involving extensive participant- observation fieldwork in health and allied health training contexts in New Zealand and internationally. Over thirty in-depth semi-structured interviews were carried out with health, allied health and social service professionals in New Zealand. This data has been subjected to a thematic analysis that informs the scope of the research discussion, and provides the basis for my conclusions. Based on this data, my research suggests that professionals do indeed come into contact with cases of prenatal alcohol exposure in their work, and that many have developed innovative strategies for assisting individuals with confirmed or suspected FASD, but continue to face systemic and social barriers to achieving best practice in this area.