fasd (fetal alcohol spectrum disorders ) and drug exposure
TRANSCRIPT
FASD (Fetal Alcohol Spectrum Disorders ) and
Drug Exposure in Children
Eileen B. Bisgard, [email protected]
Summary• Alcohol & Drugs – teratogens• Alcohol – the worst of all• How the fetus is changed• Physical Characteristics• Primary Behavioral Characteristics• Secondary Behavioral Characteristics• What a Caregiver Can Do
Alcohol and Drugs
Teratogens – go through the umbilical cord into the baby’s
bloodstream
Alcohol
The worst of all
Cause of the Damage
Effect on the BrainTypical Infant Infant with FAS
Every Individualis Different
Some Have Many Effects,
Some Have Feweror None
Alcohol Can Cause Irreversible Damage Before the Mother
Knows She is Pregnant
Timeline of Fetal DevelopmentWeek 5 6 7 8 9 10 14 18 22-38 40
Central Nervous System
HeartArms
Legs
Ears
Teeth Eyes
PalateExternal Genitalia
Missed Period Noted Typical time of first prenatal visit
Diagnoses Under FASD Umbrella
Fetal Alcohol Syndrome (FAS)
Partial Fetal Alcohol Syndrome (pFAS)
Alcohol Related Birth Defects (ARBD)
Alcohol Related Neurodevelopmental Disorder (ARND)Static Encephalopathy
ND‐PAE(DSM 5 definition)
Most are Invisible Physical Disorders
Descriptive Termsfor the Whole Spectrum
FASDFetal Alcohol
Spectrum Disorders
ND-PAENeurobehavioral Disorder
Associated with Prenatal Alcohol Exposure
Describe the whole range of disorders caused by maternal alcohol used during gestation.
FASD is not a diagnosis. ND-PAE is.
FASD- a missing piece of the puzzle
Screening for Affected Child• Interview Mother or Other Family
Member– Discuss alcohol use pattern – a couple of beers
on the weekends, wine or champagne on special occasions, etc.
– Discuss the pregnancy, including asking how far along she was when she found out she was pregnant.
– Ask if the alcohol use pattern continued until she found out that she was pregnant.
• That is enough to affect the child
Physical Characteristics of Alcohol - Affected
Individuals
Physical Characteristics
• Language delays• Poor eye-hand coordination• Poor muscle tone• Unusual sensitivity to environment
(sensory defensiveness)• Dyslexia• Lower IQ
Physical Characteristics• Sensory Defensiveness
• Tactile defensiveness (Hypersensitive skin)
• Oral defensiveness• Gravitational or postural insecurity
• Visual defensiveness• Auditory defensiveness
• Unusual sensitivity to taste or smell
IQ Distributions in FAS & FAE (Streissguth, 1996)
Streissguth, 1996.
Mental Health Problems• Hyperactivity & ADHD (e.g., Coles et al., 1997;
Mattson & Riley, 2000; Nanson & Hiscock, 1991; Kodituwakku et al., 1995; Connor et al., 1999). )
• Depression (e.g., Famy et al., 1998)• Conduct Disorder, Oppositional Defiant
Disorder, Behavior Problems (e.g., Fast et al., 1999; Mattson & Riley, 1998)
• Social Skill Deficits (e.g., Thomas et al., 1998) • Alcohol & Substance Abuse (Famy et al., 1998)• Bi-polar Disorder (e.g., Famy et al., 1998)
•
Behavioral Characteristics
Behavioral Characteristics
• Primary CharacteristicsBehaviors that reflect differences in brain
structure and function
• Secondary CharacteristicsBehaviors developed over time because
of a “poor fit” between the childand the environment
Diane Malbin, M.S.W.
Primary Characteristics
Behaviors that reflect differences in brain
structure and function
Diane Malbin, M.S.W.
Difficulty Making Decisions•May not understand behavior & consequence(cause & effect)
•Minds often disorganized•Can’t process options•Therefore, Impulsive Decisions
Memory Problems•Poor Short Term Memory•Memory comes and goes•Can’t follow directions•May be only visual or auditory memory issue
Can’t Think Abstractly
• Think concretely – Black and White
• Don’t understand cause & effect, behavior & consequence
• Can’t predict outcomes = can’t plan for the future
• Can’t move rules to a new context
Can’t Think Abstractly• Don’t understand time• Can’t handle money• Don’t understand teasing or jokes• Don’t understand friend vs. stranger,
safety from danger• Mis-interpret body language• Have trouble with any change in their
lives
Disorganized Mind• Can’t organize their life• Don’t know how to get started
on things• Get very tired
– Disorganized brain = more effort = tired
– May be angry and irritable and not realize that they’re tired
Perseveration
• Get stuck in a thought• May repeat things over and over• Refuse to stop what they’re
doing or change tasks• Angry at being interrupted• Need closure
Wide Differences in Abilities• May say more than they
understand• May know things that they can’t
express• Refuse read but not understand• May think slowly and therefore
miss part of what is said – mis-interpret
Slow Thinking or Hearing• Takes longer to respond• Only hears part of what’s said• Becomes overloaded by normal
speech• “Off the wall” comments or
filler speech
Slow Cognitive Development• May behave like a much younger
individual• Motor skills may exceed danger
awareness• May not reach adult maturity
until 30 or 35, if ever
Speech and Language Characteristics
• Slow to use speech and language• Halting speech, stuttering, stammering• May use picture language• Incessant chatter, nonsense questions• Difficulty retrieving words, long pauses• May repeat TV stories as their own• Off topic in conversation• May often interrupt• May need to “translate” words to
understanding
Brain deficits affect behavior!
SECONDARY(Developed)
BEHAVIORALCHARACTERISTICS
Overload, Fatigue Cause:• Frustration• Disruptive behavior• Irritability • Touchiness• Resentfulness • Tantrums
Avoidance Causes:
• Shut down• Appearing not to care• Truancy • Running away
Attempt to Control Causes:• Rigidity • Resistance• Bossiness• Bullying• Arguments with peers,
authority figures
Being or Feeling Different Causes:
• Isolation • Few friends • Picked on• Taken advantage of• Joining negative peer group
Impulsivity Causes:
• “Going along” with peers• Sexual acting out• Gang membership• “Stupid crimes”
Fear Causes:• Anxiety• Anxiety about the future (partly
because of the difficulty predicting the future)
• Dependence• Poor self concept, esteem• Depression• Hypochondriac, somatic complaints
• May take the place of communicating emotional needs
Overlaps - Primary Behaviors and Secondary Characteristics
Primary Behavior Secondary BehaviorLying
Confabulation, Attempt toor filling in the protect self fromblanks punishment,
shame
StealingFailure to under- Attempt to buystand ownership friends
Overlaps - Primary Behaviors and Secondary Characteristics
Primary Behavior Secondary BehaviorDestructive
Curiosity, little Result of angerunderstanding and frustrationof value of objects
Saying “I don’t know” or “I don’t care”Slow cognitive or Avoidance, resultor auditory pace of frequent failure
Effect on Caregivers
Effect on Caregivers• Constant tension of living with rage
and confusion• Feelings of incompetence• Traditional therapists may see the
caregivers as uncaring and/or incompetent
• Caregivers become frustrated when others treat the individual as lazy and/or defiant
When Behavior Management Doesn’t
Work
Interventions
InterventionDetermine whether each behavior
is primary (because of brain differences) or secondary
(learned)
Distinguish Between CAN’T and WON’T
Guidelines• Observe behaviors objectively
– Time of day– Is the individual hungry or tired– People present (how many and who?)– Recent changes for the individual– Trigger for the behavior– Results of the behavior for the individual
• Look for patterns and what they say about the individual
• Observe positive behaviors – not just negative ones
Guidelines• Assess the individual:
– Strengths– Developmental age– Behavior when hungry or tired– Speed of processing– Ability to abstract– Ability to follow directions– Decision-making ability
Guidelines
• Ask “What if” the behaviors reflect neurological differences?
• Err on the side of assuming the individual doesn’t understand or can’t do what’s asked.
Guidelines• Look at the “fit” between the
individual and the environment.– Sensitivity to stimuli– Cues to frustration– Memory problems– What do the behaviors say?
• Fatigue, Fear, Failure, Frustration?
• Include the individual in the discussion
InterventionIf the child CAN’T do what’s
asked,Modify the Environment
Work with what he/sheCAN DO
Modify Your Expectations
Caregiver Buy-in is Essential!
Environmental Modifications: Learning Basic Rules/Routines
• Consider understanding of cause & effect when developing behavior plans
• Provide immediate & frequent feedback for positive & negative behaviors –emphasize rewarding positive behaviors– Remember all the rewards in the world will be
unsuccessful in motivating someone to do something that is beyond his/her capabilities.
Get Thorough Testing• Start with Child Find or School
Testing• Get OT, Audiology, etc. Testing• Teens – Get a Neuropsychological• Fight for Special Education• Consider Sensory Issues
What a CaregiverCan Do
• Help child understand his condition
• Include the child in developing solutions to problem behaviors
• Identify strengths, skill and interests
• Create chances for success; limit failure
What a CaregiverCan Do
• Prevention is more effective than any response!
• Learn to identify early warning signs & intervene early by reducing stressors in the individual’s environment
InterventionsBe Creative!
Interventions• Understand how the individual
processes• Accept the person’s condition as a
medical disability • Identify the developmental age• Provide routine and structure rather
than control
InterventionsDecision-Making
• Give safe, simple choices• Avoid open-ended decisions• Create structure - consistent
expectations• Talk about cause and effect in
ordinary situations
InterventionsMemory
• Use lists and charts as reminders• Be prepared to repeat the same thing
over and over• Understand that an individual may
learn something one day, forget it the next, and remember it another time
• Give only single directions
InterventionsConcrete Thinking
• Be as concrete and literal as you can• Say exactly what you mean• Avoid teasing or jokes• Avoid abstract expressions like “cut it
out”, “cool it”, get ahead (a head)• Tell the person specifically what you
want
TAKE “DON’T”OUT OF YOURVOCABULARY
InterventionsDisorganized Mind
• Use as much structure/routine and consistency as you can
• Be sure expectations are ALWAYS the same
• Prepare the person if something is going to change (substitute caregiver, schedule change)
InterventionsPerseveration
• If the individual gets frustrated or angry when working on a task, try taking a break, then trying again
• Provide enough time to finish activities – make the activities short enough to be completed in the time given
• Create transitions between activities
InterventionsAbility Differences
• Understand that an individual may be able to express more than he understands
• Another person may understand but can’t communicate what he knows
InterventionsAbility Differences
• Teach using all of the senses:– Tell him– Show him– Let him feel it
• Role play situations that are likely to come up
InteventionsSlow Thinking or Hearing
• Speak slowly, simply and clearly• Give enough time to respond• Understand that mis-understanding
may be because of guessing• Check this issue if you think the
person is “lying”
Other Interventions
• Role play social skills• Help develop skills for expression
of feelings• SUPERVISE carefully
Other Interventions
• Establish relationships for the individual in each environment in which he/she functions
• Limit TV times - be selective• Understand that a lesson must be
taught over for each new situation
Other Interventions• Create an “external brain”
– Have a regular schedule set– Have a support person even for adults– Create clear rules and reminders– Have clear directions for common
situations– Have activities that support the
schedule
Where to StartLook at
Developmental Age
Remember:The Individual’s Brain Is
Different
You Cannot Love, Parent, or Behavior Manage away Brain
Differences
Nevada ResourcesFASD – Nevada Act Early https://www.nevadaactearly.org/for-parents/learn-signs/fetal-
alcohol-spectrum-disorder-fasd/
FAS Community Resource Center http://www.come-over.to/FASCRC/
JUSTin Hope Foundation – Northern Nevada https://www.nofas.org/state-resources-for-nevada/
NOFAS – National Organization on Fetal Alcohol Syndrome https://www.nofas.org/state-resources-for-nevada/
(Put ME (Put ME (Put ME (Put ME Here!)Here!)Here!)Here!)
Dear Supporter of Me, This book is a way to help you get to know me a little bit better. I have some struggles because my brain was affected by alcohol before I was born. Alcohol changed the way my brain developed, and this can show up as a BEHAVIOR BEHAVIOR BEHAVIOR BEHAVIOR issue issue issue issue instead of a BRAIN issueBRAIN issueBRAIN issueBRAIN issue. I want to do my best. I want to wake up in the morning feeling excited about my day, and I want to go to bed at night feeling good about myself. Thank you so much for reading this booklet, and for learning as much as you can about Fetal Alcohol Spectrum Disorders and the ways that prenatal alcohol exposure can affect learning and behavior. I am so
happy and grateful to have you in my life right now. Sincerely,
I have people in my life who love me very much. Here are some of the things that the people closest to me like BEST about me:
________________ ____________________ _______________
When I am feeling down about myself, it helps me to be reminded of these When I am feeling down about myself, it helps me to be reminded of these When I am feeling down about myself, it helps me to be reminded of these When I am feeling down about myself, it helps me to be reminded of these things. You will find things that YOU like best about me, too.things. You will find things that YOU like best about me, too.things. You will find things that YOU like best about me, too.things. You will find things that YOU like best about me, too.
My favorite ways to spend my time are: ___________________________
__________________________
__________________________
These interests can help motivate me to These interests can help motivate me to These interests can help motivate me to These interests can help motivate me to
learn and explore.learn and explore.learn and explore.learn and explore.
There is not e
nough
darkness in th
e world
to put out th
e light in
a loved child
’s eyes.
I respond best to people who are:I respond best to people who are:I respond best to people who are:I respond best to people who are: � patient � structured � calm � fast-paced � unstructured � energetic � positive � organized � consistent � critical � cluttered � inconsistent � ___________ � _____________ � _____________
Getting to Know Me...Getting to Know Me...Getting to Know Me...Getting to Know Me...
My birthday is: ______________________
I have ____ brothers and ____ sisters.
My Medical History...My Medical History...My Medical History...My Medical History... I have been assessed and diagnosed with the following conditions, in I have been assessed and diagnosed with the following conditions, in I have been assessed and diagnosed with the following conditions, in I have been assessed and diagnosed with the following conditions, in
addition to my history of prenatal alcohol exposure:addition to my history of prenatal alcohol exposure:addition to my history of prenatal alcohol exposure:addition to my history of prenatal alcohol exposure: � ADHD � Reactive Attachment Disorder � Diabetes � ADD � Oppositional Defiant Disorder � Epilepsy � Depression � Conduct Disorder � Heart Condition � Anxiety � Visual Impairments � Bipolar Disorder � ______________________ � ___________________________ � ______________________ � ___________________________
I currently take the following medications:I currently take the following medications:I currently take the following medications:I currently take the following medications: Medication: This how much I take: This is when I take it: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
My IQ:My IQ:My IQ:My IQ:
� My IQ hasn’t been evaluated.
My IQ was evaluated on this date: _________
My IQ was measured to be: ___________
Comments: ___________________________
_____________________________________
My Adaptive Age:My Adaptive Age:My Adaptive Age:My Adaptive Age: � My Adaptive Age hasn’t been evaluated.
My Adaptive Age was evaluated on this date: _______________________
My Adaptive Age was measured to be at these levels: Expressive Language: _____ Reading Ability: _____ Comprehension: _____ Social / Emotional Skills: _____
Comments: _____________________ ________________________________
Other Assessments:Other Assessments:Other Assessments:Other Assessments:
My Emotional Responses...My Emotional Responses...My Emotional Responses...My Emotional Responses... Sometimes I have problems expressing emotions in appropriate ways. This gets in the way of my learning, my friendships and my daily life. You can help me
by recognizing my true emotions and supporting me to manage my emotions in healthy ways. I might not always be able to do this on my own.
I get upset when:I get upset when:I get upset when:I get upset when: � I don’t understand � Things move too fast for me � I feel like I don’t fit it � I can’t remember something � Someone touches me � I’m overwhelmed � I don’t know what questions to ask
I show my emotions by:I show my emotions by:I show my emotions by:I show my emotions by: � acting defiant � raising my voice � pestering � physical movement � physical aggression � giving up � withdrawing � talking too much
All kids get upset. However, I can’t always depend on the part of my brain that regulates emotions. My response to situations may be exaggerated or
inappropriate, and I may not be able to regain control on my own. Please recognize how hard I try, even though my behavior may be challenging.
You can help me by:You can help me by:You can help me by:You can help me by: � Noticing my cues of frustration � Speaking slowly and calmly to me � Gently reminding me that I’m losing control � Guiding me to a quiet place where I can regain control with dignity � Listening to the feelings behind my behavior
Sometimes my emotions bring me past the point of being rational. This is Sometimes my emotions bring me past the point of being rational. This is Sometimes my emotions bring me past the point of being rational. This is Sometimes my emotions bring me past the point of being rational. This is called a Meltdown. called a Meltdown. called a Meltdown. called a Meltdown. If I reach this point, I NEED you to calmly remove me to a If I reach this point, I NEED you to calmly remove me to a If I reach this point, I NEED you to calmly remove me to a If I reach this point, I NEED you to calmly remove me to a
quiet space so I can regain control. Trying to talk to me or reason with me quiet space so I can regain control. Trying to talk to me or reason with me quiet space so I can regain control. Trying to talk to me or reason with me quiet space so I can regain control. Trying to talk to me or reason with me when I’m in the middle of meltdown will only frustrate both of us. when I’m in the middle of meltdown will only frustrate both of us. when I’m in the middle of meltdown will only frustrate both of us. when I’m in the middle of meltdown will only frustrate both of us. Wait until Wait until Wait until Wait until
I’ve calmed down before talking about what happened.I’ve calmed down before talking about what happened.I’ve calmed down before talking about what happened.I’ve calmed down before talking about what happened.
It’s so important that you
remember this question: WHAT IF
the behavior is showing something about my
brain? WHAT IF I really am doing the
best I can? Sometimes
my best doesn’t look like everyone
else’s.
Prenatal Alcohol Exposure Prenatal Alcohol Exposure Prenatal Alcohol Exposure Prenatal Alcohol Exposure and the Brainand the Brainand the Brainand the Brain
There are some areas that are often a struggle for people with prenatal alcohol exposure. My brain and I have
challenges with the following things:
Learning from experience..Learning from experience..Learning from experience..Learning from experience.. I have a hard time applying what I
know to different situations. Every situation is brand new to me because I don’t always
have the benefit of using past experiences to guide my actions.
Brain pace.Brain pace.Brain pace.Brain pace. I am a 30-Second Kid in a 5-Second World. This means
that I think at a slower pace. It may take me longer to
respond to you because my brain needs more time to process what
you’ve said.
Understanding cause and effectUnderstanding cause and effectUnderstanding cause and effectUnderstanding cause and effect. I am sometimes not able to look
ahead and predict what might happen. This means that I am
likely to make impulsive decisions, and then be
surprised at the outcomes. Typical behavior plans might not
work for me because of this.
Thinking abstractly.Thinking abstractly.Thinking abstractly.Thinking abstractly. I am a very literal, concrete thinker.
This means that I may not understand phrases that say
one thing and mean another. (“Watch your mouth.”
“Pick up your room.” “Do the right thing.” etc.)
Prenatal Alcohol Exposure Prenatal Alcohol Exposure Prenatal Alcohol Exposure Prenatal Alcohol Exposure and the Brainand the Brainand the Brainand the Brain
There are some areas that are often a struggle for people with prenatal alcohol exposure. My brain and I have
challenges with the following things:
Rigid thinking.Rigid thinking.Rigid thinking.Rigid thinking. Once I’ve learned something, it’s very hard for me to re-learn it or change it. For example, if we have to sit
quietly in the gymnasium for a guest speaker, this might be hard for me because to me the gym is
only for playing.
Reading body language.Reading body language.Reading body language.Reading body language. I am not able to understand non-verbal communication, like tone of voice,
facial expression or body language. This means that I often don’t understand what is really being
communicated, and makes it hard for me to get along with other kids.
Memory.Memory.Memory.Memory. My short-term memory is inconsistent, which means that sometimes I remember things and
sometimes things get lost in my brain. I might be able to repeat something to you, and then forget it
as soon as I walk away.
Sensory Integration.Sensory Integration.Sensory Integration.Sensory Integration. I experience my senses differently than most people. This means that a
slight touch may feel like a slap, or normal lights may look like strobe lights. It makes it harder to
get through the day when I struggle with things that seem normal to everyone else.
What Works…..What Works…..What Works…..What Works….. I CAN learn, I CAN get through my day feeling good about myself, and I CAN have successes. Here are some ideas that
help create outside supports for my brain.
Use concrete languageUse concrete languageUse concrete languageUse concrete language. I don’t speak the language of abstractions, so I often don’t understand what you mean. Pay attention to your
words and try to use language that means exactly what it says.
Expect to reteach things to me. Expect to reteach things to me. Expect to reteach things to me. Expect to reteach things to me. I struggle with my memory. I need to re-learn things over and over
before they stick in my brain. Don’t get frustrated with me for
forgetting. I don’t mean to forget.
Provide external memory tools.Provide external memory tools.Provide external memory tools.Provide external memory tools. It helps me not to always have to
rely on my memory. Lists, reminders, cue cards—anything that can be an external memory
for me will help me be more successful.
Speak slowly, and use fewer words.Speak slowly, and use fewer words.Speak slowly, and use fewer words.Speak slowly, and use fewer words. If you’re wanting to explain
something to me and I’m just not getting it, try slowing down and
using fewer words. I process information at a slower pace, so it’s easy for too many words to
overwhelm me.
Sometimes you will wonder if I am misbehaving on purpose or if I am acting from my brain differences. Here’s an idea for you: Try assuming that my actions are from a brain difference, and put some supportive strategies consistently in place. If my behavior gets better, your
strategies and your patience are HELPING me and my brain. Thank you!!
What Works…..What Works…..What Works…..What Works…..
“Please don’t let what I CAN’T do interfere “Please don’t let what I CAN’T do interfere “Please don’t let what I CAN’T do interfere “Please don’t let what I CAN’T do interfere
with what I CAN do!”with what I CAN do!”with what I CAN do!”with what I CAN do!”
Understand what routine means to me. Understand what routine means to me. Understand what routine means to me. Understand what routine means to me. Since my brain has trouble looking ahead, routine is what makes me feel secure. When my
routine gets disrupted, I feel anxious because I don’t know what’s happening next. Prepare me for changes.
Use the same words.Use the same words.Use the same words.Use the same words. If you say, “Don’t run” “Walk, please” And “Slow down,” my brain may not understand that you’re
wanting the same behavior each time. Use the exact same words / phrases to help my brain understand what’s expected.
Provide extra supervision.Provide extra supervision.Provide extra supervision.Provide extra supervision. It helps to have people around me who understand that my brain works differently, and can help me navigate new and unfamiliar situations. Unstructured times are especially hard for me, so I might need extra help.
Be as specific as possible.Be as specific as possible.Be as specific as possible.Be as specific as possible. I have a hard time figuring out all the steps that need to be done, and in what order to do them. Help me organize and break tasks down into small parts (and don’t expect me to rely on memory - write it down for me!)
RememberRememberRememberRemember————maybe it’s not maybe it’s not maybe it’s not maybe it’s not that I WON’T that I WON’T that I WON’T that I WON’T do it. Maybe do it. Maybe do it. Maybe do it. Maybe it’s that I it’s that I it’s that I it’s that I
CAN’T do it.CAN’T do it.CAN’T do it.CAN’T do it.
The Environment…..The Environment…..The Environment…..The Environment…..
It’s easy to figure out how to make the environment accessible to a person with a physical disability. Sometimes it’s
harder to look at my disability in the same way. There are simple changes in the environment that can make a big
difference for me.
Help me eliminate clutter Help me eliminate clutter Help me eliminate clutter Help me eliminate clutter
from my space. from my space. from my space. from my space. A messy desk or locker can be
overwhelming to me, but I have a hard time knowing what to throw away and what to keep.
I also have a hard time organizing information.
Allow me to have ways to filter Allow me to have ways to filter Allow me to have ways to filter Allow me to have ways to filter
out distractions.out distractions.out distractions.out distractions. Noise and visual stimulation make it hard for me to concentrate. Let me
sit up front, where I will be less distracted. I might need earplugs or sunglasses to
help me filter out my environment.
Keep the environmentKeep the environmentKeep the environmentKeep the environment organized.organized.organized.organized.
Clutter in the classroom or on the walls can be overwhelming to me. If my surroundings are
tidy and organized, this will help my brain make sense of things.
Remember the Remember the Remember the Remember the
question, “What hasquestion, “What hasquestion, “What hasquestion, “What has changed in the environment”changed in the environment”changed in the environment”changed in the environment”
if my behavior suddenlyif my behavior suddenlyif my behavior suddenlyif my behavior suddenly changes.changes.changes.changes.
Even changes that seem very small can be dramatic in my life. Help me adapt to changes by showing me, rather than just telling me,
what is expected of me.
Looking for More Information About Looking for More Information About Looking for More Information About Looking for More Information About Fetal Alcohol Spectrum Disorders?Fetal Alcohol Spectrum Disorders?Fetal Alcohol Spectrum Disorders?Fetal Alcohol Spectrum Disorders?
The Sycamore Project: Kentucky’s Prevention Enhancement Site The Sycamore Project: Kentucky’s Prevention Enhancement Site The Sycamore Project: Kentucky’s Prevention Enhancement Site The Sycamore Project: Kentucky’s Prevention Enhancement Site for FASD: for FASD: for FASD: for FASD: 859-624-3622, x732 or [email protected]
http://comehttp://comehttp://comehttp://come----over.to/FASCRCover.to/FASCRCover.to/FASCRCover.to/FASCRC “Fetal Alcohol Syndrome Community Resource Center” This website provides facts, resources and information including
diagnostic tools, pictures, research / journal articles, strategies for intervention (in English and Spanish) and training opportunities.
Resources and links are included.
http://www.von.ca/fasd/_fasdtool_fullproof_final.pdfhttp://www.von.ca/fasd/_fasdtool_fullproof_final.pdfhttp://www.von.ca/fasd/_fasdtool_fullproof_final.pdfhttp://www.von.ca/fasd/_fasdtool_fullproof_final.pdf “Let’s Talk FASD”
This free, downloadable guidebook provides information, stories, examples and resources for people seeking to support a person with brain differences
caused by prenatal alcohol exposure. It’s long, but well worth the read.
http://www.fasalaska.com/EvensenFASDmanual.pdfhttp://www.fasalaska.com/EvensenFASDmanual.pdfhttp://www.fasalaska.com/EvensenFASDmanual.pdfhttp://www.fasalaska.com/EvensenFASDmanual.pdf “Making A Difference: Working with Students Who Have FASD” This free, downloadable guidebook was written specifically for educators,
but applies to anyone wanting to learn from the experience of others when working with a person living with FASD. It’s long, but well worth the read.
Thank you so much for taking the time to learn Thank you so much for taking the time to learn Thank you so much for taking the time to learn Thank you so much for taking the time to learn more about how my brain and I work!!!more about how my brain and I work!!!more about how my brain and I work!!!more about how my brain and I work!!!
Prepared By: Prepared By: Prepared By: Prepared By:
Bluegrass Prevention CenterBluegrass Prevention CenterBluegrass Prevention CenterBluegrass Prevention Center The Sycamore Project:The Sycamore Project:The Sycamore Project:The Sycamore Project:
Kentucky’s Prevention Enhancement Site Kentucky’s Prevention Enhancement Site Kentucky’s Prevention Enhancement Site Kentucky’s Prevention Enhancement Site for Fetal Alcohol Spectrum Disordersfor Fetal Alcohol Spectrum Disordersfor Fetal Alcohol Spectrum Disordersfor Fetal Alcohol Spectrum Disorders
401 Gibson Lane401 Gibson Lane401 Gibson Lane401 Gibson Lane Richmond, KY 40475Richmond, KY 40475Richmond, KY 40475Richmond, KY 40475 859859859859----624624624624----3622, x7323622, x7323622, x7323622, x732
[email protected]@[email protected]@bluegrass.org
Funded by a grant from Funded by a grant from Funded by a grant from Funded by a grant from Kentucky’s Division of Behavioral Health / Substance AbuseKentucky’s Division of Behavioral Health / Substance AbuseKentucky’s Division of Behavioral Health / Substance AbuseKentucky’s Division of Behavioral Health / Substance Abuse
Behavior Record Observations of positive & negative behaviors to help analysis
of child’s strengths & needs
Child __________________________________ Date________________
What was the behavior? ______________________________________________________________________
______________________________________________________________________
Time of day___________________
Was the child hungry or tired? ________________________________________
Was the child being asked to transition?____________
From _____________________ to __________________________________
People present (how many and who?) _____________________________________
Is the environment familiar _____ or unfamiliar _____ to the child?
Are there unusual noises, visual stimuli, or other sensory issues? _____
If yes, what? ____________________________________________________
Have there been recent changes for the child? ____________
What changes? _________________________________________________
Did the child seem lost/confused? ______________________
Did the child appear to be physically overwhelmed or unable to connect with reality during the episode? _________________________
What was the apparent trigger for the behavior?____________________________
After the episode did the child appear foggy and disoriented? _________________
What were the results of the behavior for the child? ______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Did the child seem to expect these results? ______________
Has this behavior happened before? If so, compare with the above information.
______________________________________________________________________
Eight Magic Keys: Developing Successful
Interventions for Students With FAS
While there is no recommended “cookbook approach” to working with students with FAS, there are strategies that work, based on the following guidelines:
1. Concrete - Students with FAS do well when parents and educators talk in concrete terms, don’t use words with double meanings, idioms, etc. Because their social-emotional understanding is far below their chronological age, it helps to "think younger" when providing assistance, giving instructions, etc. 2. Consistency - Because of the difficulty students with FAS experience trying to generalize learning from one situation to another, they do best in an environment with few changes. This includes language. Teachers and parents can coordinate with each other to use the same words for key phases and oral directions.
3. Repetition - Students with FAS have chronic short-term memory problems; they forget things they want to remember as well as information that has been learned and retained for a period of time. In order for something to make it to long term memory, it may simply need to be re-taught and re-taught.
4. Routine - Stable routines that don’t change from day to day will make it easier for students with FAS to know what to expect next and decrease their anxiety, enabling them to learn.
5. Simplicity - Remember to Keep it Short and Sweet (KISS method). Students with FAS are easily overstimulated, leading to "shutdown" at which point no more information can be assimilated. Therefore, a simple environment is the foundation for an effective school program.
6. Specific - Say exactly what you mean. Remember that students with FAS have difficulty with abstractions, generalization, and not being able to "fill in the blanks" when given a direction. Tell them step by step what to do, developing appropriate habit patterns.
7. Structure - Structure is the "glue" that makes the world make sense for a student with FAS. If this glue is taken away, the walls fall down! A student with FAS achieves and is successful because their world provides the appropriate structure as a permanent foundation.
8. Supervision - Because of their cognitive challenges, students with FAS bring a naivete to daily life situations. They need constant supervision, as with much younger children, to develop habit patterns of appropriate behavior.
When a situation with a student with FAS is confusing and the intervention is not working, then:
• Stop Action!
• Observe.
• Listen carefully to find out where he/she is stuck.
• Ask: What is hard? What would help?
Eight Magic Keys: Developing Successful
Interventions for Students With FAS
1. Concrete 2. Consistency 3. Repetition 4. Routine 5. Simplicity 6. Specific 7. Structure 8. Supervision
Fetal Alcohol Syndrome FASD in a Nutshell
■ Fetal alcohol spectrum disorders (FASD) refers to FAS and other alcohol-related birth defects.
■ FASD is the leading known cause of mental retardation.
■ Most people with FASD test higher on an IQ test than they are capable of functioning in real life.
■ FASD causes serious social and behavior problems.
■ Each year in the US 40,000 babies are born with FASD.
■ No amount of alcohol is known to be safe during pregnancy.
■ Alcohol causes more damage to a baby than any other drug.
■ FASD is 100% preventable.
Based on Fasstar Information Series Brochure 1200MK1
Eight Magic Keys: Developing Successful
Interventions for Students With FAS
Fasalaska Project FACTS (Fetal Alcohol Consultation and Training Services)
Developed by Deb Evensen and Jan Lutke 1997
Used with permission
fascenter.samhsa.gov 866-STOP-FAS (786-7327)
FASD SCREEN
Name of Child: ______________________________ Date of Birth:__________________ Name of Biological Mother:______________________ Date of Birth:__________________ Was the pregnancy normal with this child? Y / N
How far along were you (or the mother) when you found out you were pregnant?
How far along was the pregnancy at the time of birth? (Number of weeks)
Has this child ever:
o Had any academic difficulties? Y / N
o Ever failed in math? Y / N
o Ever been suspended, expelled, or dropped out of school? Y / N
o Had an IEP? Y / N (Receiving Special Education services)
What age were you (or the mother) when you had your first drink?
What did you drink before you got pregnant? (Beer, wine, wine coolers or liquor/mixed drinks)
How often did you drink before you got pregnant?
Did your normal drinking pattern continue until you found out you were pregnant? Y / N Is it possible that you (or the mother) drank at all before you knew you were pregnant? Y / N
Was this child or any of your children born with alcohol or drugs in their system? Y / N
Overlapping Characteristics & Mental Health Diagnoses
FASD
ADD/ ADHD
Sensory Int. Dys.
Autism Bi-Polar
RAD Depres- sion
ODD Trauma Poverty
Organic Organic Organic Organic Mood Mood Mood Mood Environ Environ Easily distracted by extraneous stimuli X X Developmental Dysmaturity X X Feel Different from other people X X Often does not follow through on instructions
X X X X X X
Often interrupts/intrudes X X X X X X X Often engages in activities without considering possible consequences
X X X X X X
Often has difficulty organizing tasks & activities
X X X X X X
Difficulty with transitions X X X X No impulse controls, acts hyperactive X X X X X Sleep Disturbance X X X X Indiscriminately affectionate with strangers X X X X Lack of eye contact X X X X X Not cuddly X X X X Lying about the obvious X X X Learning lags: “Won’t learn, some can’t learn”
X X X X X
Incessant chatter, or abnormal speech patterns
X X X X X
Increased startle response X X X Emotionally volatile, often exhibit wide mood swings
X X X X X X X X X
Depression develops, often in teen years X X X X Problems with social interactions X X X X Defect in speech and language, delays X X Over/under-responsive to stimuli X X X X Perseveration, inflexibility X X X Escalation in response to stress X X X X X X Poor problem solving X X X X Difficulty seeing cause & effect X X Exceptional abilities in one area X X Guess at what “normal” is X X Lie when it would be easy to tell the truth X X X Difficulty initiating, following through X X X X Difficulty with relationships X X X X X X Manage time poorly/lack of comprehension of time
X X X X X
Information processing difficulties speech/language: receptive vs. expressive
X X
Often loses temper X X X X X X Often argues with adults X X X Often actively defies or refuses to comply X X X Often blames others for his or her mistakes X X X X X Is often touchy or easily annoyed by others X X X X Is often angry and resentful X X X
Overlapping Behavioral Characteristics of FASD & Related Mental Health Diagnoses in Children
Cathy Bruer-Thompson, Adoption Training Coordinator, Hennepin County, MN 612-543-0014 [email protected] 7/22/08 With much appreciation to the many who edited and contributed
References and Resources for
�“Overlapping Behavioral Characteristics and Related Mental Health Diagnoses in Children�”
Diane Malbin: Clinical social worker, program developer, nationally recognized trainer on FASD and consultant, co-founder of FASCETS (Fetal Alcohol Syndrome Consultation)
MOFAS (Minnesota Organization on Fetal Alcohol Syndrome): www.mofas.org
NAMI: National Alliance on Mental Illness - factsheets on mental health diagnoses, characteristics, medications, resources, local support groups for many mental illnesses
http://www.nami.org/Template.cfm?Section=By_Illness
Attention Deficit Hyperactivity Disorder Autism Spectrum Disorder Bi-Polar Disorder Reactive Attachment Disorder Obsessive-Compulsive Disorder Post Traumatic Stress Disorder
Bruce D. Perry, M.D., Ph.D.: Senior Fellow of The ChildTrauma Academy
His neuroscience research has examined the effects of prenatal drug exposure on brain development, the neurobiology of human neuropsychiatric disorders, the neurophysiology of traumatic life events and basic mechanisms related to the development of neurotransmitter receptors in the brain.
Bessel van der Kolk, MD: clinician, researcher and teacher in the area of posttraumatic stress and related phenomena, Medical Director of The Trauma Center, a program of Justice Resource Institute
“Developmental Trauma Disorder: A New Rational Diagnosis for Children With Complex Trauma Histories,” by Bessel van der Kolk, Psychiatric Annals, May 2005.
“Complex Trauma in Children and Adolescents,” Cook, Spinazzola, Ford, Lanktree, Blaustein, Cloitre, DeRosa, Hubbard, Kagan, Mallah, Olafson, van der Kolk, 2005, Psychiatric Annals, pp. 390-398- Psychiatric Annals, May 2005.
Also “Attachment, Self-regulation and Competency (ARC)”
Mayo Clinic: Reactive Attachment Disorder Symptoms
http://www.mayoclinic.com/health/reactive-attachment-disorder/DS00988/DSECTION=symptoms
Walter D. Buenning, PhD, Licensed Psychologist
Reactive Attachment Disorder Child Checklist of Characteristics http://www.reactiveattachmentdisordertreatment.com/childattachchecklist.pdf
Ruby K. Payne, Ph.D.: A Framework for Understanding Poverty and Bridges Out of Poverty
Research focuses on the effects of poverty on students, families, and communities and how to better understand and support people from all economic backgrounds
In addition this document was reviewed for accuracy by several Minnesota experts in Children’s Mental Health and Fetal Alcohol Spectrum Disorders