in-utero trauma: prenatal exposure to alcohol & drugs...affecting people who were prenatally...
TRANSCRIPT
In-Utero Trauma: Prenatal Exposure to
Alcohol & Drugs
PresentedbyBarbClark
Fetal Alcohol Spectrum DisordersFASD
• MostpeoplehaveheardofFAS,FetalAlcoholSyndrome.It
becameaspectrumdisorderin1996.
• FASDsareasetofphysical,behavioralandcognitivedisorders
affectingpeoplewhowereprenatallyexposedtoalcohol.
• FASDsarepermanentdisabilities thatresultinlifetimebrain
injury/damage.
• FASDsare100%preventableandthenumberoneknowncause
ofintellectual disability.
3 Types of Trauma-Bruce Perry
• Intrauterineinsult- prenatalalcoholordrugexposure,stress
duringpregnancy
• Earlyneglect;motherwhoisinattentiveduetostress,
depression,domesticviolence,etc.,Orphanage
• Classictraumasuchasabuse,witnessingviolence,etc.
The FASD U
mbrella
FetalAlcoholSpectrum
Disorder isanumbrellaterm.
¢ Fetal Alcohol Syndrome -FAS. (1973): 3 facial features, growth deficits, meet the cognitive profile
¢ Alcohol Related Neurodevelopmental Disorder- ARND (1996)-new name for FAE (Fetal Alcohol Effect): No physical features but brain was impacted by the alcohol. Must have confirmation of alcohol exposure in utero and match the cognitive profile.
¢ Partial Fetal Alcohol Syndrome- pFAS (1996): Have some of the physical features but not all. Match the cognitive profile
¢ DSM 5 (2013): Can list any FASD as: “other specified neurodevelopmental disorder” [315.8] Then add the specifier: “neurodevelopmental disorder associated with prenatal alcohol exposure” (ND-PAE)
Fetal Alcohol SyndromeFacial Features
– SmoothPhiltrum
– Thinupperlip
– Shortpalpebralfissures
Only 10-20% of people on the spectrum have
the facial features
Alcohol or drugs:
Which is more damaging to a
developing fetus?
ALCOHOL!!
“Ofallthesubstances ofabuse(including cocaine,heroin, andmarijuana), alcoholproducesbyfarthemostserious neurobehavioraleffectsinthefetus.”
—IOM Report to Congress, 1996
Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus
Prenatal Substance Abuse: Short- and Long-term Effects on the Exposed Fetus; Marylou Behnke, MD, Vincent C. Smith, MD, Pediatrics. 2013 Mar;131(3):e1009-24. doi: 10.1542/peds.2012-3931. Epub 2013 Feb 25.
Factors that impact the degree of brain injury to the developing fetus
– Timingofexposure
– Resiliencyoffetus
– Metabolismanddietofthemother
– Ifmom’s ironlevelislow,morelikelyfetusisdamaged
– Bloodalcoholconcentrationofthemother
Prevalence
u2018researchestimatesthat1outof20childrenhaveanFASD,butmostlygoundiagnosedoraremisdiagnosed.(May,2018).
u1outof59childrenhaveanAutismdiagnosisaccordingtotheCDC.AutismandFASDhavemanysimilarities.
*May,P.A.,etal.PrevalenceofFetalAlcoholSpectrumDisordersin4USCommunities. JAMA.OnlineFebruary6,2018.
Graphics and info put together by Proof Alliance
Red Flagsquestion to consider
• Wasthechildinfostercareorishe/sheadopted?• Itisestimatedthat80%ofchildreninfostercarewereprenatally
exposedtoalcoholandhaveanFASD.
• 29-68%ofRussianadoptionsareestimatedtoshowseverealcohol-relateddamage
• IsthereHistoryofchemicaldependency issuesforchildorfortheirparents?
• IsChild iseasilydistracted,hyperactive,inattentiveandimpulsive?
• Havetheybeeninvolvedwiththecriminaljusticesystem?
• DoesthechildcontinuetoMakethesamemistakes?
• Doesthechildappeartonotlearnfromconsequences?
Red Flags
• Canthechildrepeatarule,butcannotfollowit?• Aretheremultiple diagnoses likeBi-Polar,ADHD,ReactiveAttachmentDisorder,Autism,ConductDisorder,etc.?
• DoesthechildConsistentlydisplayextremebehaviors(aggression,emotional instability)?
• ArethereSleepingand/oreatingIssues?• DoestheindividualhaveanAverageIQbutfunctionsatamuchlowercapacity?
• AreVividfantasiesandperseverationproblemspresent?• Doestheindividual seemunawareofwhattheyhavedoneorwhytheyareintrouble?
4th-6th Grades
Aroundtheagesof9-11,difficultiesinacademic
performanceandbehaviorintheschoolsettingbecomemore
apparent.
ItisimportanttoconsiderscreeningforanFASDifparentsareexpressingconcernsovernewbehavioralissuesand/oracademicstrugglesparticularlyaroundthe
4thto6thgradelevel.
StrengthsuHighlyverbaluEnergetic,hardworkinguCaring,kindandloyaluCuriousandinvolveduFriendly/likeableuTalkativeuStrongdesiretobelikeduDon’tholdagrudgeuGoodwithyoungerchildrenuNotmaliciousuEverydayisanewday!
Corpus Callosum
– Typical – FAS
Impulse Control
– FrontalLobe,partofExecutivefunctionskills
– Impactsangerresponse,takingthings(stealing),sexualchoices,cursingorverbalaggression
Memory struggles
– Thereisadifferencebetweenshorttermandlongtermmemory.
– Shorttermmemoryiswhatiscalledworkingmemory.
– WorkingmemoryisalmostalwaysadeficitinpeoplewithanFASD
Difficulty Generalizing
– Struggletotransferskillstodifferentsituations,withdifferentpeople,differentplaces,etc.
– 4+4=8
– 4
+4
8
Math Struggles
– WhenFASDchildrenwereimagedbyatechniquecalledDTI(DiffusionTensorImaging),the5areasinthebrainimportantinmathematicalabilityshoweddamage–andtheamountofdamagecorrelatedhighlywiththeirmathscoresonstandardizedtests.
ANXIETY
– HeartrateIncreases
– Bodytemprises
– BodyTensesup
– Alltiedtobrainfunction
– Keepanxietyaslowaspossiblethroughsensorybreaks,interventions,relaxedtesting(ifany),etc.
Typical symptoms/challenges
– Difficultywithabstractconcepts
– Inabilitytomanagemoney
– Difficultywithunderstandingthepassageoftime
– Patternoflying
– Poorproblemsolvingskills
– Stubbornness/perseveration– Verysimilartochildrenwithautism
– Attentiondeficits&hyperactivity
– Strugglewithdelayedgratification
FASD Developmental TimelineACTUALAGEOFINDIVIDUAL:18
Skill Developmental age equivalent
Expressive Language =================================> 20 Comprehension =======> 6 Money, time concepts =======> 8 Emotional maturity ==> 6 Physical maturity ================================> 18Reading ability ==============================> 16Social skills ===========> 7 Living skills ===================> 11
WERECOMMENDYOUTAKETHEAGEOFANINDIVIDUALWITHANFASD,ANDCUTTHEIRAGEINHALF.THISISTHEAGETHEYAREPROBABLYFUNCTIONINGATINMOSTAREASOFLIFE.ADAPTEDFROM:RESEARCHFINDINGSOFSTREISSGUTH,CLARRENETAL,.DIANEMALBIN1994
Developmental Quadrant
Physical/Chronologic Emotional
CognitiveSocial
14 4
6 9
Developmental Quadrant
Physical/Chronologic Emotional
CognitiveSocial
14 6
6 9
Parent/teach to this age
Advocate at school regarding this ageProvide support and guidance
with and about peers & safety measures
Strategies
Last serny, Fingledobe and Pribinwere in the nerd-link trepperinggloopy caples and cleaming burly greps.
Suddently a ditty strezzle boofedinto Fingledobe’s tresk. Pribin glapedand glaped.
“Oh Fingledobe!” He Chifed, “That ditty strezzle is tunning in your grep!”
Top six strategies…
v Rememberitisbraindamage!!
v Bepatientandgivegrace!!
v Changetheenvironment!!
v Don’taskwhy!!
v Don’tmatchfirewithfire!!
Reframe
– Moveawayfromconstantconsequenceswhichproduceanxiety
– Childismorelikelytolearnskillswhennotanxious&angry
Rage
– Removeothersifpossibleorremovetheindividualfromthearea.Ensuresafety.
– Donotfocusonstoppingthebehavior,focusoncalmingthearousal.Donotthechildtocalmdownmorethanonce!!!
– Staycalm,andtrytotalkaslittleaspossible.
– Avoidusingthechild’sname over&over.
– Donotpointoutconsequences- perceivedasthreatwhenchildisintheredzone
Confabulation(otherwise referred to as “lying”)
• “amemorydisturbance,definedastheproductionoffabricated,distortedormisinterpretedmemoriesaboutoneselfortheworld,withouttheconsciousintentiontodeceive”
• Weneedtolookatthe“lying”or“confabulation”whileweacknowledgetheanxiety,whethervisibleorhidden,thatisgoingonwithinthechild.
• Whenunderpressure,itisalmostagiventhecorrectstorywillnotcomeout.
• Fillinginthe“holes”intheworkingmemory.Wouldratherlook“bad”than“stupid”.
ConfabulationHow to handle
• Ifchildseemsworkedup,waituntillateroradifferentdaytoconfrontthestory.
• Needtowaituntiltheyareinagood,clearmind(orasclearasthestudentevergets),totalkaboutitandprocessit
• Whenprocessing,donotshame,blameorembarrassthechild.Thisisapartoftheirbraindamage/disability
• Talkcalmlyandrespectfullyabouttheimportanceoftruthandhavingtherightfacts
Sensory Strategies
¢ minitrampolineorlargetrampoline.
¢ Haveanareawheretheymayretreatifoverloaded.
¢ Earprotection/noise cancellingheadphonescanbeworntoreduceauditorystimulation.
¢ Haveavarietyoffidgetsavailable.
¢ Frequentopportunitiesthroughoutdayforphysicalactivity.
¢ Snackandwaterbreakeverytwohours.
¢ Besensitive tosensoryissues.
Won’t vs. Can’t
– Weoftenhearpeoplesay,“whywon’thedothis?”
– Weneedtosay,”whycan’thedothis?”
– Andtheanswerisoften“BrainDamage
Advice
uSupervisionisIMPORTANT!!
uBepatient.Re-teach.Changeexpectations.
uDon’tgivemultistepdirections.Keepitsimple.
uRememberourindividualsoftenusethewrongwordswhenitcomestofeelings.
uWaterandsnackseverytwohoursisimportant.
uRemindyourself:BRAININJURY!
uExpectinconsistencyandcelebrateitwhenyouarewrong!
Homework: a reduction or elimination of homework might be necessary
Especiallyifthereisatraumahistoryoutsideofthewomb
Visual Timers
www.timetimer.com
Sand Timers
www.schoolspecialty.com
Teach the difference between fair & equal
Websites
uProofAllance (formerlyMOFAS)u www.proofalliance.org
uNationalOrganizationonFetalAlcoholSyndrome
uwww.NOFAS.org
uCentersforDiseaseControl(CDC)
u https://www.cdc.gov/ncbddd/fasd/facts.html
Books
Ø TryDifferentlyRatherThanHarder,DianeMalbin
ØDamagedAngels,BonnieBuxton
Ø TheBestICanBe,LizKulp
ØWhenRainHurts,MaryEvelynGreene
Ø FetalAlcoholSyndrome,AnnStreissguth
Ø TheBraidedCord,Liz&Jodee Kulp
Barb Clark
FASD Educator & [email protected]
Parent Support & Training Specialist at the North American Council on Adoptable Children (NACAC)[email protected], x13