Working with kids with Fetal Alcohol Spectrum Disorders (FASD)
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Transcript of Working with kids with Fetal Alcohol Spectrum Disorders (FASD)
Working with kids with
Fetal Alcohol Spectrum Disorders
(FASD)
MN Organization on Fetal Alcohol Syndrome 2
FASD Timeline
Feb 2013
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US Map– Centers for Disease Control, 2010
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Minnesota Pregnancy Drinking Statistics
• Almost half of pregnancies are unplanned (contraception failure or lack of use), 28% of births are unplanned. (Henshaw, 1998)
• 20% of pregnant women continue to drink after finding out they are pregnant. (Stratton et al 1996)
• In MN, about 12% of women consume five or more drinks per month during pregnancy. (Taking A Closer Look MDH 2002)
• In MN, about 5% binge-drink (5 or more drinks at a time) during pregnancy. (Taking A Closer Look MDH 2002)
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What are the facts?
• Alcohol use during pregnancy does not always result in FASD
• Most children with FASD go undiagnosed
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An Under-Identified Disorder
• More Common than Autism • Leading cause of intellectual
disability in North America• FASD occurs in all racial,
ethnic and socioeconomic groups
• Often misdiagnosed due to lack of information and awareness
(See Overlapping Characteristics)• DSM barrier• 100% Preventable
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Incidence of fetal alcohol spectrum disorders– Minnesota Statistics - CDC 2006; National Statistics - March of Dimes; NOFAS 2004.
Down's Syndrome
Cerebral Palsy
Spina Bifida
FASD0
2
4
6
8
10
12
1.25
3
1
10
Prevalence of Birth Defects Per 1,000 Live Births
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What are Fetal Alcohol Spectrum Disorders
(FASD)? • A set of physical, behavioral, and cognitive
disorders seen in individuals exposed to alcohol prenatally
• Lifetime disability with brain injury that never goes away
• Broad range (spectrum) of characteristics that vary from person to person
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The FASD UmbrellaFetal Alcohol Spectrum Disorders
Fetal Alcohol Syndrome (FAS) Partial Fetal Alcohol
Syndrome (pFAS)
Fetal Alcohol Effects (FAE) replaced by ARBD & ARND in 2006
Alcohol-Related Birth Defects
(ARBD)
Alcohol-Related Neurodevelopmental Disorder (ARND)
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Areas of Diagnostic Evaluation
1. Facial Dysmorphia
2. Growth Problems
3. Central Nervous System Abnormalities
4. History of Maternal Alcohol Exposure
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FAS Facial Characteristics
Thin upper lipPalpebral fissures
Smooth, long philtrumCDC 2004Might also have: Low set ears, flat mid-face, up-turned nose, small chin, and epicanthal folds.
FAS Facial Characteristics – Image courtesy of FASTAR..
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FASD & the Brain
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National Organization on Fetal Alcohol Syndrome (NOFAS), 2004; Adapted from Moore, 1993.
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Newborn Brain
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Brain Damage• Failure of certain brain regions (e.g., the
corpus callosum) to develop• Failure of certain cells to migrate to their
appropriate locations during embryonic brain development
• A tendency for the tissue to die in some brain regions (e.g., the cerebellum)
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Winter 2000 issue of Alcohol Research & Health
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Prenatal exposure to alcohol causes permanent
brain injury that never goes away.
Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.
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Most Affected Areas of the Brain
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Corpus Callosum• Attention
• Intellectual function
• Executive functioning
• Learning
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Cerebellum• Movement, motor control• Balance & equilibrium • Muscle tone• Ability to judge distances• Involved in some cognitive processes
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Basal Ganglia• Can affect spatial memory and behaviors
– Perseveration– inability to switch modes– work towards goals– predict behavioral outcomes
• Time perception
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Frontal Lobes• Impulse control
• Self regulation
• Executive Functions-– Linking 2 or more ideas together– Understanding abstract or complex concepts – Generalizing (ex. Learning to cross street)– Understanding cause & effect / consequences– Judgment
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Prenatal Alcohol Exposure and Information Processing
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• input (taking information in from the senses)
• integration (interpreting information, making sense of it)
• memory (storing information for later use, connecting with previous experiences)
• output (response, behavior)
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Look at the chart and say the color not the word
YELLOW BLUE ORANGE BLACK RED GREENPURPLE YELLOW REDORANGE GREEN BLACK BLUE RED PURPLE
LEFT-RIGHT CONFLICTYour right brain tried to say the color but your
left brain insists on reading the word.
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Strategies
Sensory Processing• What is it exactly?• Taking in and
making sense of incoming data
• Having an appropriate response to the data received
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Problems with Sensory Processing
Under Responsive• Excessive need to touch• Spinning• On the move• Floppy• Likes swinging• Crashing• Roughhousing• Limited body space
awareness
Over Responsive• Avoids touch• Struggles when picked up• Aversion to play dough• Doesn’t like hair comb• Doesn’t like barefoot• Doesn’t like playground
equipment• Doesn’t like feet not on the
ground
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Intervention Strategy Ideas• Calm and Quiet
environment• Limit number of
objects on walls and hanging
• Calm Colors on Walls• Define Spaces (eating,
playing, resting)• Establish rules for
cleanup and transition
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Intervention Strategies• Quiet routine activities
to help stay organized• Sing small songs to
help with routine activities
• Focus on cause and effect activities
• Increased language stimulation activities
• Set limits
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Intervention Strategies• Breaks instead of
timeouts• Define space around
child – armrests, bean bags
• Teach relaxation• Keep It Short and
Simple• Add movement to
learning
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Adapt the Environment
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Slides Courtesy of Canada FASD curriculum.
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Strategies for Transitions• Timers• Songs• Picture schedules• Establish routines • Child with transition difficulty becomes the
helper• May need to avoid waiting in lines
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Eight Simple Keys• Concrete• Consistency• Repetition• Routine• Simplicity (KISS)• Specific• Structure• Supervision
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Recognize Strengths!• Friendly, cuddly, happy• Caring, kind and loyal• Curious and involved • Energetic, hard working• Fair and cooperative• Artistic or musical • Highly verbal • Long term visual
memory
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Resources
MN FASD Diagnostic Clinics
FASD Clinic; Essentia Health, Children’s Services
Treehouse PsychologyNative American Community Clinic
Lakewood Health System FASD Diagnostic Clinic
White Earth FASD Diagnostic Clinic
Centra care FASD Clinic
Bluestem CenterStillwater Medical Group
MOFAS FASD Diagnostic ClinicCanvas Health FASD & Neurodevelopmental Disorders Diagnostic Clinic
International Adoption Clinic – U of MN
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Park Nicollet Diagnostic Clinic
U of MN FASD ProgramHealthEast Behavioral Pediatrics Clinic
Online Resources• General Information on FASD
– Center for Disease Control and Prevention, FAS site
• http://www.cdc.gov/ncbddd/fas
– FASD Unit @ the Univ of Washington School of Medicine
• http://depts.washington.edu/fadu/
– MOFAS Resource Directory – • http://www.mofas.org
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Don’t Try Harder Try Differently
If you’ve told a child a thousand times and he still does not understand, then it is not the child who is the slow learner. - Walter Barbee
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Contact Information:MOFASPhone: 651-917-2370www.mofas.org