Identifying and Preventing Fetal Alcohol Spectrum Disorders (FASD):

A Hidden Cause of Relapse in Women As Well As Behavioral and Cognitive Problems in Their Offspring

Kathleen Tavenner Mitchell, MHS, LCADC

Vice President

National Organization on Fetal Alcohol Syndrome

Prenatal Alcohol Exposure can cause Prenatal Alcohol Exposure can cause Lifelong Brain DamageLifelong Brain Damage

FASD is the leading known FASD is the leading known cause of preventable mental cause of preventable mental retardation and is a leading retardation and is a leading cause of birth defects and cause of birth defects and learning and behavioral learning and behavioral disorders disorders

COMPARISON OF CONGENTIAL EFFECTS COMPARISON OF CONGENTIAL EFFECTS FROM ALCOHOL AND DRUGSFROM ALCOHOL AND DRUGS

Alcohol Cocaine Heroin Marijuana Tobacco

Decreased birthweight

x x x x x

Small for gestional age

x

Mental Retardation

x

Newborn CNS problems

x x x x x

Withdrawal x Physical anomalies

x

Adapted from Morris et al,

FAS ARND PFAS

Fetal Alcohol Syndrome Alcohol-Related

Neurodevelomental Disorder

Partial FAS

NOFAS VisionNOFAS Vision

The vision of the The vision of the National Organization on Fetal National Organization on Fetal Alcohol Syndrome (NOFAS)Alcohol Syndrome (NOFAS) is a global is a global community free of alcohol-exposed pregnancies community free of alcohol-exposed pregnancies and a society supportive of individuals already and a society supportive of individuals already living with Fetal Alcohol Spectrum Disorders living with Fetal Alcohol Spectrum Disorders (FASD)(FASD)

What Does NOFAS Provide?What Does NOFAS Provide?

Public Awareness Public Awareness Media OutreachMedia OutreachPSAPSAAwareness CampaignsAwareness Campaigns

Youth EducationYouth Education

Professional EducationProfessional Education CurriculaCurricula Provider trainingProvider training

www.nofas.orgwww.nofas.org

AdvocacyAdvocacyGovernment AffairsGovernment AffairsAdvisoryAdvisory

Constituent ServicesConstituent ServicesAffiliate NetworkAffiliate NetworkBirth Mom NetworkBirth Mom NetworkSupport GroupsSupport GroupsConsultationConsultationReferralReferral

FASD: FASD: AN UNEXAMINED CAUSEAN UNEXAMINED CAUSE

OF ADDICTION RELAPSE OF ADDICTION RELAPSE

Women that have used during pregnancy have Women that have used during pregnancy have severe guilt and shame that needs to be severe guilt and shame that needs to be addressed in order to prevent relapse addressed in order to prevent relapse

Women that have children with unidentified Women that have children with unidentified FASD are at high risk for relapse due to the FASD are at high risk for relapse due to the behaviors of their children and the belief that behaviors of their children and the belief that they are poor parentsthey are poor parents

Women that were exposed to alcohol prenatally Women that were exposed to alcohol prenatally may have FASD putting them at high risk for may have FASD putting them at high risk for relapse relapse

FASD Prevention and Intervention Should be FASD Prevention and Intervention Should be a PRIORITY in Addiction Treatment a PRIORITY in Addiction Treatment

Early identification of children with FASD can reduce Early identification of children with FASD can reduce secondary disabilities and improve outcomes for future secondary disabilities and improve outcomes for future successsuccess

Women with addictive diseases are at very high risk for Women with addictive diseases are at very high risk for having children with FASD having children with FASD

Women who drank during one pregnancy are likely to drink Women who drank during one pregnancy are likely to drink during all pregnanciesduring all pregnancies

FASD is a preventable disorder that has lifelong FASD is a preventable disorder that has lifelong implications!!! implications!!!

Increased sibling mortality in Increased sibling mortality in children with FAS children with FAS

Study compared the rate of all causes of mortality in siblings Study compared the rate of all causes of mortality in siblings of children diagnosed with FAS with the siblings of matched of children diagnosed with FAS with the siblings of matched controls controls

The siblings of children with FAS had increased mortality The siblings of children with FAS had increased mortality (11.4%) compared with matched controls (2.0%), a 530% (11.4%) compared with matched controls (2.0%), a 530% increase in mortality increase in mortality

Siblings of children with FAS had increased risk of death due Siblings of children with FAS had increased risk of death due to infectious illness and SIDS to infectious illness and SIDS

A diagnosis of FAS is an important risk marker for mortality in A diagnosis of FAS is an important risk marker for mortality in siblings even if they do not have FAS siblings even if they do not have FAS

Maternal alcoholism appears to be a useful risk marker for Maternal alcoholism appears to be a useful risk marker for increased mortality risk in diagnosed cases and their siblings increased mortality risk in diagnosed cases and their siblings

Authors: Burd L.; Klug M.; Martsolf Authors: Burd L.; Klug M.; Martsolf 2004 2004

Substance Use in PregnancySubstance Use in Pregnancy

More than 130,000 More than 130,000 pregnant women per pregnant women per year in the US year in the US consume alcohol at risk consume alcohol at risk levelslevels

1 in 30 women who 1 in 30 women who know they are pregnant know they are pregnant report “risk drinking”report “risk drinking”

16-to-24-year-old American Women and 16-to-24-year-old American Women and AlcoholAlcohol

After drinking alcohol: One in five have had sex that

they regretted One in 10 have been unable

to remember if they had sex the night before

One in seven women have had unprotected sex and engage in “risk drinking”

Birth defects associated with Birth defects associated with alcohol exposure can occur before alcohol exposure can occur before a woman knows she is pregnanta woman knows she is pregnant

Nearly 85% of teen pregnancies Nearly 85% of teen pregnancies are unplannedare unplanned

National Clearinghouse for Alcohol and Drug Information

Social DifferencesSocial Differences

Physicians EnablePhysicians Enable Frequent misdiagnosisFrequent misdiagnosis

• Less likely to be screened for Less likely to be screened for alcohol problemsalcohol problems

CASA reports that only 6% of CASA reports that only 6% of physicians routinely talk to women physicians routinely talk to women about alcohol useabout alcohol use

• Over-prescribing, or Over-prescribing, or inappropriate prescribing inappropriate prescribing addictive substancesaddictive substances

Is Alcoholism Really a Disease?Is Alcoholism Really a Disease?

Alcoholism is defined as a Alcoholism is defined as a primary, chronic disease with primary, chronic disease with genetic, psychosocial, and genetic, psychosocial, and environmental factors environmental factors influencing its development influencing its development and manifestations and manifestations

Stage 1Stage 1

ToleranceTolerance

Stage 2Stage 2

Physical DependencyPhysical Dependency

Stage 3Stage 3

Major Organ ChangeMajor Organ Change

high tolerance high tolerance with with

occasional useoccasional use

increased increased tolerance/possible a.m. use tolerance/possible a.m. use

possible daily or possible daily or maintenance use maintenance use (reduced tolerance)(reduced tolerance)

occasional occasional hangovers hangovers

withdrawal: withdrawal: headaches/nauseaheadaches/nausea

(anorexia, high BP, loss of (anorexia, high BP, loss of concentration, weakness)concentration, weakness)

migrainesmigraines

VomitingVomiting

rapid pulse, BPrapid pulse, BP

disorientationdisorientation

disrupted sleep disrupted sleep patternspatterns

sleeplessnesssleeplessness insomniainsomnia

colds/infections colds/infections disease pathology disease pathology developingdeveloping

major organ damagemajor organ damage

irritability-mood irritability-mood swings-mild swings-mild depression-depression-isolationisolation

MH diagnosis (depression, MH diagnosis (depression, anxiety, panic) anxiety, panic) institutions and rxinstitutions and rx

suicidal ideation or suicidal ideation or attempts attempts

K. Mitchell, 2004K. Mitchell, 2004

Progression of Alcoholism

Stage 1Stage 1

Tolerance Tolerance

Stage 2Stage 2

Physical Physical DependencyDependency

Stage 3Stage 3

Major Organ Major Organ Change Change

memories of how memories of how nice use wasnice use was

preoccupation/ preoccupation/ cravingcraving

use despite use despite consequencesconsequences

one-two gateway one-two gateway drugsdrugs

variety of drug usevariety of drug use multiple drug multiple drug addictionsaddictions

mild tremors mild tremors intentional tremorsintentional tremors seizures or D.T’s seizures or D.T’s

sexual pleasuresexual pleasure sexual problemssexual problems impotence impotence

family problemsfamily problems school & work school & work problemsproblems

loss of family, job & loss of family, job & school school

trouble with the law trouble with the law (close calls)(close calls)

DWI-DUI / possessionDWI-DUI / possession incarcerationsincarcerations

K. Mitchell, 2004K. Mitchell, 2004

Myth:Myth: An addict will not go into treatment until An addict will not go into treatment until

they have hit bottomthey have hit bottom

Truth:Truth: An addict lives on an emotional bottom, An addict lives on an emotional bottom,

we just need to take the time to tell them we just need to take the time to tell them

Our Families Journey Through Addiction, Our Families Journey Through Addiction, Denial and RecoveryDenial and Recovery

19771977

Karli, Danny and ErinKarli, Danny and ErinA Happy Little Hippy FamilyA Happy Little Hippy Family

Karli age 10 (diagnosed with cerebral palsy)

Our Family Process:Our Family Process:

o Years of frustration and misdiagnosisYears of frustration and misdiagnosis

o Years of believing that Karli was not Years of believing that Karli was not trying her besttrying her best

o Believing that Karli would “grow out of it”Believing that Karli would “grow out of it”

o Received Diagnosis of FAS for Karli (16 Received Diagnosis of FAS for Karli (16 year of age)year of age)

Acceptance PhaseAcceptance Phase

o Survival: Do or Die!Survival: Do or Die!o Catapulted into Process of Catapulted into Process of

RecoveryRecovery

Karli at 16 Receives Diagnosis of FASKarli at 16 Receives Diagnosis of FASNew house rules:New house rules:

No discussing what Karli cannot do!No discussing what Karli cannot do!The focus changed to what Karli could The focus changed to what Karli could

do:do: Great artist!Great artist! Friendly to everyoneFriendly to everyone Wants to be helpful Wants to be helpful Everyone likes Karli Everyone likes Karli 100% pure of heart, 100% pure of heart, HolyHoly Would not hurt another Would not hurt another

person-ever! person-ever! Really wants your Really wants your

approval approval Great with the elderly and Great with the elderly and

individuals with severe individuals with severe handicapping conditionshandicapping conditions

Karli possessed a natural Karli possessed a natural ability for spiritual ability for spiritual

simplicity!simplicity!

Maybe she was here to teach Maybe she was here to teach us??… us??…

The glass was now half full!!The glass was now half full!!

“We are not human beings having a spiritual

experience, rather spiritual beings having a human

experience.”Pierre Teihard de

Chardin

Individuals with FASD make Individuals with FASD make Powerful Advocates!Powerful Advocates!

2 Things Necessary for Life:2 Things Necessary for Life:

water water womenwomen

Screen All Women of Childbearing Age Screen All Women of Childbearing Age for Alcohol Usefor Alcohol Use

Be conversational during screeningBe conversational during screening Be non-judgmentalBe non-judgmental Listen to her, both verbal and non-verbal Listen to her, both verbal and non-verbal Stay positive-refrain from negative comments or Stay positive-refrain from negative comments or

reactionsreactions Focus on her health and her babies Focus on her health and her babies Consider issues such as illiteracy, poverty or abuseConsider issues such as illiteracy, poverty or abuse Compliment her Compliment her

Day’s Study: Light-to-Moderate Prenatal Day’s Study: Light-to-Moderate Prenatal Alcohol Exposure Can Negatively Effect Alcohol Exposure Can Negatively Effect

Cognitive Abilities of ChildCognitive Abilities of Child Examined prenatal substance use among 611 mother-child Examined prenatal substance use among 611 mother-child

pairs in a prenatal clinic from 1983 to 1985 pairs in a prenatal clinic from 1983 to 1985

Children examined several times throughout the child’s early Children examined several times throughout the child’s early life, at age 10 cognitive ability was assessed life, at age 10 cognitive ability was assessed

The study noted that even light to moderate drinking during The study noted that even light to moderate drinking during pregnancy can affect IQ, and that the effects of prenatal pregnancy can affect IQ, and that the effects of prenatal alcohol exposure on IQ were worse for children exposed to alcohol exposure on IQ were worse for children exposed to alcohol through the second trimesteralcohol through the second trimester

IQ is a measure of a child’s ability to learn and survive in his IQ is a measure of a child’s ability to learn and survive in his or her own environment-ideally predicting the child’s abilities or her own environment-ideally predicting the child’s abilities and potential for success in school and everyday activities and potential for success in school and everyday activities

Willford, Jennifer A., Sharon L. Leech, and Nancy L. Day. "Moderate Prenatal Alcohol Willford, Jennifer A., Sharon L. Leech, and Nancy L. Day. "Moderate Prenatal Alcohol Exposure and Cognitive Status of Children At Age 10." Alcoholism: Clinical and Experimental Exposure and Cognitive Status of Children At Age 10." Alcoholism: Clinical and Experimental Research 30 (2006): 1051-1059.Research 30 (2006): 1051-1059.

OpportunityOpportunity

Pregnancy is an opportunity for changePregnancy is an opportunity for change Women who are pregnant are more receptive to Women who are pregnant are more receptive to

intervention programs and treatment than women intervention programs and treatment than women who are not currently pregnantwho are not currently pregnant

Discuss Birth Experiences with Women:Discuss Birth Experiences with Women:

Red Flags: Red Flags: Two or more miscarriages? Two or more miscarriages? Stillbirths?Stillbirths? Infant/child deaths (SIDS)?Infant/child deaths (SIDS)? Children with LD, ADHD, MH or behavioral disorders?Children with LD, ADHD, MH or behavioral disorders? Children diagnosed with FASD?Children diagnosed with FASD?

Positive response to any of the above questions should warrant a Positive response to any of the above questions should warrant a screening of all children for possible FASD (where substance use is screening of all children for possible FASD (where substance use is known or suspected) known or suspected)

K Mitchell, 2004K Mitchell, 2004

Women identify the top three barriers to Women identify the top three barriers to addiction treatmentaddiction treatment

39% said the inability to admit the problem is severe 39% said the inability to admit the problem is severe enough to warrant treatment (denial)enough to warrant treatment (denial)

32% said the lack of emotional support for treatment 32% said the lack of emotional support for treatment from family membersfrom family members

28% inability to provide adequate care for children 28% inability to provide adequate care for children

2002 Caron Foundation www.womenhealing.org

Locate Treatment that provides Locate Treatment that provides Feminine Focused Feminine Focused

Recovery:Recovery: Address the unthinkable:Address the unthinkable: SexualitySexuality Biological differencesBiological differences MenstruationMenstruation AbuseAbuse Substance use during pregnancy and possible Substance use during pregnancy and possible

consequencesconsequences SecretsSecrets Desires, dreams and fantasiesDesires, dreams and fantasies Basic needs: transportation, childcare, etc.Basic needs: transportation, childcare, etc.

Recovery begins when we:

Change thinking:

From linear to circular

Characteristics of Chemically Characteristics of Chemically Dependent FamiliesDependent Families

Family rules are rigid or non-existentFamily rules are rigid or non-existent Inconsistent, arbitrary, irrationalInconsistent, arbitrary, irrational

Stress related illness is commonStress related illness is common Colitis, migraine headaches, ulcers, gastrointestinal Colitis, migraine headaches, ulcers, gastrointestinal

disordersdisorders Denial is present on every levelDenial is present on every level Compulsive behaviors appear to defend against the stressCompulsive behaviors appear to defend against the stress

Overeating, oversleeping, overworking, spending, Overeating, oversleeping, overworking, spending, gambling, exercising, achievinggambling, exercising, achieving

The patterns will continue in new family system The patterns will continue in new family system

Characteristics of Chemically Characteristics of Chemically Dependent FamiliesDependent Families

Blaming and defensivenessBlaming and defensiveness Used as a means of coping and avoiding painUsed as a means of coping and avoiding pain

Isolation despite the appearance of enmeshmentIsolation despite the appearance of enmeshment There may be no emotional connection between themThere may be no emotional connection between them

Feelings are not expressed openly or appropriatelyFeelings are not expressed openly or appropriately Pain, anger sadness or hurt may be discountedPain, anger sadness or hurt may be discounted

Role transfersRole transfers Children acting parents and parents acting as Children acting parents and parents acting as

dependent childrendependent children

Rescuing Someone From Addiction: Rescuing Someone From Addiction:

RelationshipsRelationships Consider physically separating from partner/familyConsider physically separating from partner/family Teach detachment skillsTeach detachment skills

EnablingEnabling Remove client from enabling family membersRemove client from enabling family members Investigate “love verses enabling” Investigate “love verses enabling”

COA/ACOA issuesCOA/ACOA issues Educate on effects on family Educate on effects on family Relapse clients: address these early on Relapse clients: address these early on

Ways to Destroy the Culprit Ways to Destroy the Culprit ( Codependency)( Codependency)

PerfectionismPerfectionism 3 P’s (perfectionism, procrastination, paralysis)3 P’s (perfectionism, procrastination, paralysis)

VocabularyVocabulary Change “I can’t” to “I choose not to” or “I won’t” Change “I can’t” to “I choose not to” or “I won’t”

Decision makingDecision making Make everyday decisionsMake everyday decisions

ChoicesChoices Every action is a chosen actionEvery action is a chosen action

Teach H.A.L.T.Teach H.A.L.T.

3-6 Meals a Day3-6 Meals a Day Exercise (walking)Exercise (walking) 8-9 Hours of Sleep (naps okay!)8-9 Hours of Sleep (naps okay!) Practice Prayer and meditationPractice Prayer and meditation Talk to sponsor, be around positive people Talk to sponsor, be around positive people

Communication Skills:Communication Skills:

I can’t to I won’tI can’t to I won’t

Saying NO: Setting Saying NO: Setting BoundariesBoundaries

AssertivenessAssertiveness

Client’s with a Child with FASDClient’s with a Child with FASD

Extreme shame Extreme shame GriefGrief StigmaStigma Self-esteemSelf-esteem AcceptanceAcceptance

Referral for Assessments: Referral for Assessments:

Diagnostic evaluationDiagnostic evaluation Ongoing assessmentsOngoing assessments

MedicalMedical Mental healthMental health Occupational and physical therapyOccupational and physical therapy Speech and languageSpeech and language IQ and academic achievementIQ and academic achievement

Strategies for Helping Strategies for Helping Children with FASDChildren with FASD

Modify child’s environment:Modify child’s environment:

Structure * Routine * Repetition * SupportStructure * Routine * Repetition * Support

Use literal, concrete language and check Use literal, concrete language and check for understandingfor understanding

Do not isolate the childDo not isolate the child Potential child abuse Potential child abuse

Parenting StrategiesParenting Strategies

Strategies that have been modeled on Strategies that have been modeled on other developmental disabilitiesother developmental disabilities

Often, children are already receiving services; Often, children are already receiving services; make sure they are the correct servicesmake sure they are the correct services

Education, Direction, and Education, Direction, and Support for Support for

Families/CaregiversFamilies/Caregivers Educate about FASDEducate about FASD

Assist families to change family paradigm Assist families to change family paradigm “Johnny is lazy” to “Johnny’s brain does “Johnny is lazy” to “Johnny’s brain does not allow him to understand things easily” not allow him to understand things easily”

Long-term support: family counseling, Long-term support: family counseling, support groups support groups

Ongoing Case ManagementOngoing Case Management

Future support for childFuture support for child

Respite careRespite care

Possible kinship carePossible kinship care

Possible foster care placementPossible foster care placement

Help Women to Change Their Help Women to Change Their Belief Systems:Belief Systems:

Maybe Maybe II Could Experience Good Things Could Experience Good Things

in Life?in Life? Encourage her to nourish, giggle, Encourage her to nourish, giggle,

hug, create, take risks, hug, create, take risks, massage and to sit and listen massage and to sit and listen

and you will witness a and you will witness a BEAUTIFUL SOUL BLOOM !BEAUTIFUL SOUL BLOOM !

Hello SOUL-SELF!Hello SOUL-SELF!

Carl Jung’s theory of Carl Jung’s theory of synchronicity:synchronicity:

We are all connected and We are all connected and intertwine with perfect intertwine with perfect

timing. timing. There is a reason for There is a reason for

everything.everything.

There are no mistakes!There are no mistakes!

Children with Children with FASD grow FASD grow

up; we treat up; we treat them in our them in our

human human service service

agenciesagencies

University of WashingtonUniversity of WashingtonFetal Alcohol and Drug UnitFetal Alcohol and Drug Unit

In a study that examined 415 persons with FASD between In a study that examined 415 persons with FASD between the ages 6-61, the ages 6-61,

Dr. Ann Streissguth found: Dr. Ann Streissguth found:

•

Potential “Secondary Disabilities”Potential “Secondary Disabilities”

mental health problems (90%)mental health problems (90%) disruptive school experience (60%)disruptive school experience (60%) trouble with law (60%)trouble with law (60%) confinement (50%)confinement (50%) inappropriate sexual behavior (50%)inappropriate sexual behavior (50%) alcohol/drug problems (30%)alcohol/drug problems (30%) dependent living (80%)dependent living (80%) employment problems (80%)employment problems (80%)

Identifying Clients with FASDIdentifying Clients with FASD

Assessments to include:Assessments to include:• Recidivist client?Recidivist client?• Tell me about your birth experience, what was your birth Tell me about your birth experience, what was your birth

weight? weight? • Any infant/childhood health issues? Ear infections as an Any infant/childhood health issues? Ear infections as an

infant?infant?• Did your mom drink, was she an alcoholic?Did your mom drink, was she an alcoholic?• Were you raised in foster care? Adopted?Were you raised in foster care? Adopted?• Any developmental, learning issues? Ever in special ed?Any developmental, learning issues? Ever in special ed?• What was your best subject in school? Reading? Math? What was your best subject in school? Reading? Math? • Ever diagnosed with ADD or any other MH disorders? Which Ever diagnosed with ADD or any other MH disorders? Which

one’s?one’s?

Behavioral profile of FASDBehavioral profile of FASD Reduced IQ Reduced IQ Learning deficits Learning deficits Increased activity and reactivityIncreased activity and reactivity Perseverative Perseverative Attentional deficitsAttentional deficits Poor fine and gross motor skillsPoor fine and gross motor skills Developmental delaysDevelopmental delays Feeding issuesFeeding issues Hearing deficitsHearing deficits Sensory integration Sensory integration

FAS TIMELINE Actual age of individual: 18 Skill Developmental age equivalent

Expressive Language ==================================> 20

Comprehension =======> 6

Money, time concepts ========> 8

Emotional maturity ==> 6

Physical maturity ===================================> 18 Reading ability =================================> 16

Social skills ===========> 7 Living skills ====================> 11

Adapted from: Research findings of Streissguth, Clarren et al. Diane Malbin 1994

Adults with FASDAdults with FASD

Naïve Naïve VictimizationVictimization Poor judgment-easily ledPoor judgment-easily led Poor $ and time Poor $ and time

management management Difficulties with Difficulties with

independenceindependence Mental health disordersMental health disorders

Common disorders identified with FASDCommon disorders identified with FASD

Autism/Aspergers’s Autism/Aspergers’s DisorderDisorder

Attention Deficit Attention Deficit Hyperactivity Disorder Hyperactivity Disorder (ADHD)(ADHD)

Borderline Personality Borderline Personality DisorderDisorder

Attachment-Bonding Attachment-Bonding DisorderDisorder

DepressionDepression Learning disabilityLearning disability Oppositional-Defiant Oppositional-Defiant

DisorderDisorder Post Traumatic Stress Post Traumatic Stress

Disorder (PTSD)Disorder (PTSD) Receptive-Expressive Receptive-Expressive

Language DisorderLanguage Disorder Conduct DisorderConduct Disorder

Case Management Considerations:Case Management Considerations:

Systems ProblemSystems Problem

Input informationInput information

Processing (organization, storage and Processing (organization, storage and retrieval) of informationretrieval) of information

Output informationOutput information

Be Innovative and CreativeBe Innovative and Creative

Follow your intuitionFollow your intuition Watch the client and learn from the Watch the client and learn from the

messages she sendsmessages she sends

Re-Think the SystemRe-Think the System

How can we adapt our services How can we adapt our services to better serve this client?to better serve this client?

Think Younger:Think Younger: Strengths and limitationsStrengths and limitations

Inconsistent abilitiesInconsistent abilities

Issues related to chronological vs. Issues related to chronological vs. developmental agedevelopmental age

Meeting Sessions:Meeting Sessions: Set appropriate boundariesSet appropriate boundaries

Focus on client’s Focus on client’s strengthsstrengths

Address the stigma associated with FASDAddress the stigma associated with FASD

Focus on self-esteem and personal issuesFocus on self-esteem and personal issues

Address resistance, denial, and acceptanceAddress resistance, denial, and acceptance

Provide Provide hope hope

Remind client that you are staying with herRemind client that you are staying with her

Expect and Be Prepared Expect and Be Prepared For:For:

Inconsistent behaviorsInconsistent behaviors Problems with perception and de-coding information Problems with perception and de-coding information Problems with decision makingProblems with decision making May not understand timeMay not understand time ImpulsivenessImpulsiveness Poor judgmentPoor judgment Distinguishing between public and private behaviorsDistinguishing between public and private behaviors Frustration with transitionsFrustration with transitions Easily ledEasily led Need for increased 1:1 sessionsNeed for increased 1:1 sessions Need for a mentor or “buddy” Need for a mentor or “buddy”

CommunicationCommunication

Check often for client understandingCheck often for client understanding Review written materialsReview written materials Repeat informationRepeat information Use simple, concrete languageUse simple, concrete language Present ideas or instructions one at a timePresent ideas or instructions one at a time

K.I.S.S.K.I.S.S. Short term goalsShort term goals Limit cognitive assignmentsLimit cognitive assignments Constant monitoring of information Constant monitoring of information

comprehensioncomprehension Speak the same languageSpeak the same language Address issues of loss, trust, and abuse Address issues of loss, trust, and abuse

Accepting their disabilityAccepting their disability

Help client recognize their disability in Help client recognize their disability in reasoning, judgment and memoryreasoning, judgment and memory

Help client understand that everyone has Help client understand that everyone has strengths and weaknessesstrengths and weaknesses

Accept client for who they are “today”-not who Accept client for who they are “today”-not who they will be if they do this and thatthey will be if they do this and that

Ignore some of their “issues/difficulties”Ignore some of their “issues/difficulties” Recognize their effort to improveRecognize their effort to improve

Counseling Clients with Counseling Clients with FASDFASD

Remember:Remember: They will be skilled at reading your expressions They will be skilled at reading your expressions

to determine the response you expectto determine the response you expect Consider the source, while forming opinions of Consider the source, while forming opinions of

family/spouse/friends or circumstances being family/spouse/friends or circumstances being reportedreported

Much of what you say to client will probably be Much of what you say to client will probably be misunderstood and misrepresented to family misunderstood and misrepresented to family peerspeers

Stay with Client:Stay with Client: If a technique is not successful, try something new If a technique is not successful, try something new

(ADAPT THE SYSTEM OF CARE)(ADAPT THE SYSTEM OF CARE)

They can learn with lots of repetition and supportThey can learn with lots of repetition and support

12 Step recovery works for clients with addictions12 Step recovery works for clients with addictions

Use direct eye contact (unless this produces anxiety), Use direct eye contact (unless this produces anxiety), repeat things and use short term instructionsrepeat things and use short term instructions

FOLLOW YOUR INTUITION!FOLLOW YOUR INTUITION!

Adult Clients with FASDAdult Clients with FASD Long term case management Long term case management

vocational rehabilitation (job coaches)vocational rehabilitation (job coaches) reproductive health (appropriate birth control) reproductive health (appropriate birth control) transition planningtransition planning housinghousing peer/recreational involvementpeer/recreational involvement

Developmental disability servicesDevelopmental disability services Medicare/caidMedicare/caid

Supplemental Security Income (SSI)Supplemental Security Income (SSI)

Identify or Create “Natural” Identify or Create “Natural” ConnectionsConnections

Community Connections: Family:

• sisters, mothers, grandmothers, daughters, grand daughters AA/NA

• Women’s meetings, women’s retreats Women Circle’s/Clubs/Meetings

• Artist way meetings, inner child groups, quilting Spiritual Communities Social Activities Health Club/Physical Activities Clubs for Adults with Disabilities Art or yoga classes

Issues Facing Families Issues Facing Families Affected by FASDAffected by FASD

Role of family in preventing alcohol-exposed Role of family in preventing alcohol-exposed pregnanciespregnancies

Need for family to accept client’s disabilityNeed for family to accept client’s disability

Anger toward birth motherAnger toward birth mother

Family Materials: Family Materials: Guides and BooksGuides and Books

NOFAS Parent Handbook: NOFAS Parent Handbook: Fetal Alcohol Syndrome:Practical Suggestions and Support for Fetal Alcohol Syndrome:Practical Suggestions and Support for Families and Caregivers, NOFAS, Kathleen Tavenner Mitchell,2002.Families and Caregivers, NOFAS, Kathleen Tavenner Mitchell,2002.

The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary The Challenge of Fetal Alcohol Syndrome: Overcoming Secondary Disabilities, Disabilities, Streissguth, Ann. 1997.Streissguth, Ann. 1997.

VideosVideos Recovering Hope: Mothers speak out about Fetal Alcohol Spectrum Recovering Hope: Mothers speak out about Fetal Alcohol Spectrum

disorders, disorders, SAMHSA, FASD Center for Excellence, 2004 order at SAMHSA, FASD Center for Excellence, 2004 order at http://store.health.org/catalog/ProductDetails.aspx?ProductID=16955http://store.health.org/catalog/ProductDetails.aspx?ProductID=16955

Fetal Alcohol Spectrum Disorders: An Overview,Fetal Alcohol Spectrum Disorders: An Overview, NOFAS. NOFAS. http://www.nofas.org/estore/http://www.nofas.org/estore/

NewslettersNewsletters Iceberg: http://www.fasiceberg.org/Iceberg: http://www.fasiceberg.org/ Notes from NOFAS: http://www.nofas.org/news/newsletter.aspxNotes from NOFAS: http://www.nofas.org/news/newsletter.aspx

ToolsTools Toolkit for Parents and Caregivers, Toolkit for Parents and Caregivers, available through NOFAS available through NOFAS

1-800-66-NOFAS1-800-66-NOFAS

A Matter of Ethics A Matter of Ethics

Important to get an accurate diagnosis so that Important to get an accurate diagnosis so that treatment plans can be tailoredtreatment plans can be tailored

Need to refer children for evaluation as raising a Need to refer children for evaluation as raising a child with an FASD can affect recoverychild with an FASD can affect recovery

Need to be sensitive when discussing FASD Need to be sensitive when discussing FASD with clientswith clients