Fetal Alcohol Spectrum Disorders Series -...
11
1 Fetal Alcohol Spectrum Disorders Series Part II: Strategies for the Preschool and Primary School Child May 5, 2009 Karen Serrett, Ph.D. Consulting Psychologist & June Pirie, RN, MN Early Childhood Mental Health Consultant Collaborative Mental Health Care Program AD/HD Motor Planning/ Organization Daily Life Skills Adaptive Functioning Motor Skills Perspective- taking Executive Functioning Functional And Social Language Academic Achievement Intelligence Memory Brain Characteristics of Preschool Children Small “elfin-like” appearance Socially engaging and chatty “Golden” period Very active – “flitters” Poor sleep patterns Feeding problems – range from picky eaters to over-interest in food Safety concerns Difficulties with changes/transitions Difficulties with self- regulation; meltdowns
Transcript of Fetal Alcohol Spectrum Disorders Series -...
1
Fetal Alcohol Spectrum DisordersSeries
Part II: Strategies for the Preschool and Primary School Child
May 5, 2009
Karen Serrett, Ph.D.Consulting Psychologist
&June Pirie, RN, MN
Early Childhood Mental Health Consultant
Collaborative Mental Health Care Program
AD/HD
Motor Planning/Organization
Daily Life SkillsAdaptive
Functioning
Motor Skills
Perspective-taking
Executive Functioning
FunctionalAnd SocialLanguage
Academic Achievement
Intelligence
Memory
Brain
Characteristics of Preschool Children
Small “elfin-like”appearanceSocially engaging and chatty“Golden” periodVery active – “flitters”Poor sleep patterns
Feeding problems –range from picky eaters to over-interest in foodSafety concernsDifficulties with changes/transitionsDifficulties with self-regulation; meltdowns
2
Characteristics of Young Children
Difficulty focusing and sustaining attention
Easily over-stimulated
Difficulty understanding social cues; making and keeping friends; gullible
Difficulty with social play, sharing, following rules, “ownership”
Problems with impulsivity; intrusive to others
Characteristics of Young Children
Poor organizational skills; difficulty “chunking” tasks
Poor problem-solving
Difficulty with changes/transitions
Learning and attention issues often lead to behavioural problems
Memory – “tea bag” phenomenon
(con’t)
Trauma & Brain Development
Malleability of neural circuits for dealing with stress in early years.
Early experiences shape the stress response system – activation and “turning off”.Toxic stress can effect the brain architecture of infants and young children.
Severe trauma, deprivation, and neglect is stressful for infants.
3
Premji, Serrett, Benzies, & Hayden (2004)
State of the Evidence Review: Results16,913
Number of hits
665Abstracts Selected by Searchers of Potential Relevance
245Abstracts Selected by Content Experts
220Full Text Articles Reviewed
by Content Experts
112Included
Premji, Serrett, Benzies, & Hayden (2004)
State of the Evidence Review: Results112
Articles Included in Review
105Qualitative
Clinical WisdomPossible Practices
7Experimental
Studies
Protective Factors
Streissguth (1996, 2004)Early diagnosis – before the age of 6Early interventionStable, supportive familiesStaying in each living situation for an average of 2.8 yearsSupport for familiesFAS; IQ lower than 70
Retrospective, correlational data
4
General Strategies
Set up home environment
Safe, stable, nurturing, appropriately structured, and developmentally stimulating
Clear expectations & predictable basic routines
“Caregiver-child relationship is key”
– Child-led play
General Strategies
SORC- Structure, Order, Routine, and Consistency is critical
Reduces the memory load; assists in remembering rules and expectations
Changing routine is confusing; set up a simple routine for all daily activities and stick with it!!
KISS – Keep it Super SimpleSimple, clear, concrete instructions and directions
1-2 steps Avoid negatives (no “purple turtles”), sarcasm
General Strategies
Setting up the environmentReduce, reduce, reduce
Minimize visual/auditory distractionsMinimal stimulation on the wallsCover toys when not in usePlay calming instrumental musicProvide a quiet area to retreat to when overwhelmed
Use natural light when possible
5
General StrategiesUse visual cues as reminders
Pictures - “A picture to replace a 1000 words”
Objects –Carpet squares, tape - to cue personal space Footsteps - to cue directionStationary objects like a trees - to cue area
Color – coding academic subjects; ownership
Photo courtesy of Renfrew Educational Services
Picture Schedule
Picture Schedule - Remove card when done to envelope at bottom is for some children less distracting
Photo Courtesy of Renfrew Educational Services
6
Courtesy of Renfrew Educational Services
Time (abstract concept) – visual timer, hour glass, marbles, construction paper links, bottle caps
Photo courtesy of Renfrew Educational Services
Sharing, taking turns - Talking stick or “my turn” card
Photo courtesy of Renfrew Educational Services
Courtesy of Renfrew Educational ServicesPhoto courtesy of Renfrew Educational Services
7
Ownership abstract – use labels
Photo courtesy of Renfrew Educational Services
Courtesy of Renfrew Educational Services
Transitions – “stoplight” cues (green, yellow, and red)
Off-limits – stop sign, “No”, picture of number of children for an activity
Photo courtesy of Renfrew Educational Services
Positive Behaviour SupportProblems behaviours often serve a “communicative” function
Shift in perspective from behaviours being internal to being a poor “child-environment fit” –“re-framing”
Therefore, to change a child’s behaviour, modifications to the environment must occur
Teaching the child more socially appropriate, yet equally effective, alternative behaviours
8
Social Skills
Teaching social skills“Memory bin”; “hands on” practice, role play & modeling
State what “To Do” versus what “Not To Do”
Exposure to appropriate peer models – visual cues
Remind of expected behaviours prior to an activity - “wait”, “my turn”, “question” cards
Courtesy of Renfrew Educational Services
Anger ManagementTeach child to recognize and label emotions in themselves and others
Label the child’s feelingsExaggerate body language and facial expressions“Feelings” dictionary
Model “calm” behaviour; Cozy corners
Concrete reminders or visual cues of strategiesTurtle technique; “Feelings” fingerprints, gingerbread man; anger thermometer, birthday candles
9
Courtesy of Renfrew Educational Services
Cozy Corners
RelaxationProvide tactile outlets - stress balls, fidget toys, “mouthing” toys (chewelry)
Provide calming spaces/ “comfort zones”/ “hide-out holes” - cushions, tents, cubbies, swing, bean bag chair, weighted vests, “hot dog” rolls, lavender oil
Relaxation book – daily practice
Music to help self-regulate
Sand and water play
Courtesy of Renfrew Educational Services
10
Take Away MessagesUse visual cues to reduce the memory load.
Set rules and expectations at the child’s developmental level.
Be specific – with rules, praise, and constructive criticism.
Build on the child’s strengths.
Separate the child from the behaviour.
Thank you for your participation
COLLABORATIVE MENTAL HEALTH CARE
Telephone: (403) 297-4852
“Children need a Helping Hand from the
start!
KEY RESOURCES 1 of 2
FASD strategies not solutions. Region 6 FetalAlcohol Spectrum Disorder Child and Youth Sub-Committee. www.region6fasd.ca
Fantastic Antone succeeds! (1993). J. Kleinfeld & S. Wescott. University of Alaska Press: Fairbanks, Al.
Challenges and opportunities: A handbook for teachers of students with special needs with a focus on fetal alcohol syndrome and partial fetalalcohol syndrome. (1999). P. Lasser. Vancouver School Board: Vancouver, B.C.
11
KEY RESOURCES 2 of 2
Parenting children affected by Fetal Alcohol Syndrome: A guide for daily living. (2nd Edition). 1998. Society of Special Needs Adoptive Parents: Vancouver, B.C.
Tips, thoughts, ideas, practices and strategies for working effectively with children who have alcohol related disorders. 2003. The Child Guidance Clinic: Winnipeg, Mn.
TransitionsUse picture schedule to reduce anxiety
Warn the child of transitions - special music, flipping light switch, visual clock
Concrete representations of time - marbles, paper chains, milk jug caps, “3 more sleeps”
Use concrete object to assist with transition -book for storytime
To prepare for major changes/events (e.g., new school, home), use photographs and social story
Sleeping
Develop a bedtime routine; picture schedule
Calming activities closer to bedtime; music-progressively calmer to help self-regulate
Snug bedclothes; weighted blanket; bed tent
Bare bedrooms, little stimulation on walls
Minimize toys in bedroom
Soothing CD (environmental sounds, white “noise”, fan)
