Dr. Gerald Block – Psychologist

Dr. Gerald Block is a psychologist with the Saskatoon Health Region who provides services within the fields of clinical and neuropsychology.  Part of his role includes providing psychology services to adults being evaluated for a diagnosis of FASD in Central and Northern Saskatchewan.

Diagnosis as support

Contributing to diagnosis via psychological assessment is key in a multitude of ways, Dr. Block explains (including additional funding, services, educational supports, etc.), noting that the benefits extend to individuals’ families, children and support providers. Generally speaking, Dr. Block says it can be challenging for those impacted by prenatal alcohol exposure to access the interventions they require without a diagnosis.

“You can go into a medical, educational or social service setting and say ‘this is what I need to be successful,’ but having documentation of associated cognitive disabilities facilitates both the provision of individualized services or accommodations as a result of a documented disability.  This diagnostic information can also help individuals themselves understand their neurobehavioural strengths and weaknesses.”

The potential downside of diagnosis

While receiving an official FASD diagnosis is generally considered a step towards a healthier and more productive life, sometimes it can unfortunately result in undesired side effects, Dr. Block warns. When someone is being assessed for FASD, the individual, family and community must be prepared to counteract potential stigmatization.

“What I often say to people is a diagnostic assessment can do three things: make things worse, no change or better,” he says.

“Because the diagnostic assessment asks for confirmation of prenatal alcohol exposure history, it is imperative that the family and community is ready to use the associated information in positive ways and protect from it being used against individuals and families.  In recognition of this, the Canadian diagnostic guidelines, clearly describe FASD as a sensitive diagnosis.”

The most intriguing aspect of the profession with regards to FASD?

Dr. Block, Dr. Logan and Dr. Mela all describe their amazement and respect for the strength and resiliency that many individuals with FASD display – despite the many challenges and setbacks they face daily.

The biggest risks associated with FASD

Dr. Block believes the greatest hazard to individuals with FASD is refusing to accept the support that is available to them. Though the specialist acknowledges that everyone possesses strengths and weaknesses, he says those with FASD (especially teens and young adults) are at a particular disadvantage if they ignore their challenges and thus opportunities for help.

“No professional athlete gets to where they are without a coach,” he notes. “However, for teenagers and young adults in everyday life, it’s pretty hard to embrace a coach.”

FASD diagnosis rates

Due in part to the more recent emphasis of assessment and recognition of FASD within the court system (visit the FASD Centre’s Justice Page), Dr. Block says he has observed an increasing number of diagnoses. However, he adds that this increase is not overly significant from his standpoint.

A shift in focus

As explained in the FASD Diagnosis Introduction, currently multidisciplinary assessment teams examine nine areas of the brain, or domains, to determine an FASD diagnosis. Pending guideline updates – being undertaken by the Canada Fetal Alcohol Spectrum Disorder Research Network (CanFASD) – include adding a tenth domain called “Affect Regulation,” or more commonly referred to as “mental health.”

Dr. Block points out that FASD as a recognized medical disability is still in its infancy – the potential harmful effects of alcohol to a fetus were realized in 1973. In fact, the current Canadian FASD guidelines and diagnostic terms were only released by the CMAJ in 2005.

With the existing standards, Dr. Block evaluates domains three through nine, and then sends his findings to a medical doctor to evaluate physical features (i.e. head circumference, facial features, etc.). As such Dr. Block is optimistic that new regulations will bring greater focus to the psychological aspects of the disability, while still recognizing the physical attributes that may accompany it.

“In 2005 they realized that whether or not you had the facial features, there are significant neurobehavioural deficits. And over time the emphasis has really shifted to the neurobehaviour deficits, though not excluding the medical features,” he explains.

In addition to the tenth domain, the proposed guidelines suggest changing existing terminology that will define FASD as an actual diagnosis, rather than an umbrella term – thus only separating patients based on whether or not they exhibit facial features associated with the disability (smooth philtrum, wide eyes, etc.)

“I’m really hoping that more refinement will take place, and this shows the diagnostic progress being made”.  He reiterated that the facial features are relevant in confirming prenatal history but can’t fully speak to the neuropsychological effects of the disability.

“In the long run we need to simplify; we need to get more professionals diagnosing,” he concludes.