Today we will. Effects of Ethanol Exposure on the Developing Embryo. Common Challenges Across the Spectrum. Adjust Your Expectations

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Fetal Alcohol Spectrum Disorders Understanding Effects Improving Outcomes Part 4: Intervention strategies Presentation by Teresa Kellerman Director of the Fetal Alcohol Resource Center Arizona

1 Fetal Alcohol Spectrum Disorders Understanding Effects Improving Outcomes Part 4: Intervention strategies Presentation by Teresa Kellerman Director of the Fetal Alcohol Resource Center Arizona Division of Developmental Disabilities, Tucson, Arizona Today we will Review secondary disabilities Review important research Explore factors that affect behavior Understand motivation Learn the SCREAMS intervention guidelines Look at early intervention for infants Learn what works for school age children Learn how to help teens and adults Effects of Ethanol Exposure on the Developing Embryo Disrupts neurotransmitter systems: Dopamine (Druse et al., 1990), Serotonin (Tajuddin and Druse, 1999; Sari et al., 2001), Glutamate (Farr et al., 1988; Kelly et al., 1986), Histamine (Rawat, 1980), Choline (Light et al., 1989), Norepinephrine (Detering et al., 1980) ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH Vol. 29, No. 9, September 2005 Common Challenges Across the Spectrum Most children with FASD have Memory deficits Lack of impulse control Poor judgment Emotional dysmaturity Think Young Adjust Your Expectations "The greatest obstacle that individuals with FAS disorders must overcome is the chronic frustration of not being able to live up to the unrealistic expectations of others Social/Emotional Age Vineland Scores Normal Low IQ FAS --Dr. Calvin Sumner, FAS/ADHD expert Chronological Age

Secondary Disabilities 94% - Mental health issues (depression) 80% - Trouble with independent living 80% - Trouble with employment 70% - Trouble in school 60% - Trouble with the law 60% - Confinement

overload Emotional stress Neurotransmitter imbalance Family Stress Families show symptoms of Post Traumatic Stress Disorder Stress experienced by families raising children with FASD is greater than

Effective Intervention There is no single program or plan that works for all persons with FASD Each plan needs to be individualized according to the person s needs Clear understanding, realistic

2 Secondary Disabilities 94% - Mental health issues (depression) 80% - Trouble with independent living 80% - Trouble with employment 70% - Trouble in school 60% - Trouble with the law 60% - Confinement in prison or institution 45% - Legal problems with sexual behaviors 50% - 70% Adults abuse alcohol/drugs Ann Streissguth Factors that Affect Behavior Dehydration Medication Diet Fatigue Sensory overload Emotional stress Neurotransmitter imbalance Family Stress Families show symptoms of Post Traumatic Stress Disorder Stress experienced by families raising children with FASD is greater than other families. Effective Intervention There is no single program or plan that works for all persons with FASD Each plan needs to be individualized according to the person s needs Clear understanding, realistic expectations, and creative problem solving will bring about solutions that work. Assessment Tools Bayley Scales (infants, toddlers) WAIS-R or WIAT: (academics) Woodcock Johnson (processing deficits) Bender test (visual motor activities) Vineland Adaptive Behavior Scales, 2 nd Edition parent version (functional abilities) Functional Behavior Assessment Social Problem Solving Inventory (judgment) Ready for Action Reinforcements Token rewards, consequences not very effective Rewards: concrete and immediate Visual boundary markers Masking tape, labels, trays, frames Time out = quiet time to self calm Safe Haven = mentor, helper, aide Communication log, organizer Minimize stress 2

3 Intervention Guidelines: SCREAMS Model Structure: routine, easy steps, ABC Rules Cues: for meds, appointments, manners Role models: TV, movies, friends, family Environment: avoid chaos, stimulation Attitude: understand FASD neurology (who?) Meds and diet: restore balance and control Supervision: many need 24/7 Neurological signs in early years Poor habituation Irritability intense response to stress Longer time to recover from stress Sensitivity to external stimuli Feeding problems Disrupted sleep cycles Developmental delays These symptoms may or may not be present. Intervention for Infants Swaddling Soft clothing Facing away during bottle feeding Frequent feedings Frequent naps Avoid chaos and over-stimulation White noise or gentle music Sensory integration therapy Neurological signs during childhood Difficulties with bonding and attachment Inappropriately affectionate to strangers Inability to form healthy relationships Memory deficits (forget the rules) Poorly formed conscience (lying/ stealing) Stubborn, compulsive, perseverate, tantrums Arrested social development ( Think Young ) Poor judgment, lack of impulse control Memory Enhancement Instructions: simple, concrete steps Show the child how Visual cues: symbols, signs, charts Teach one skill at a time Hands on activities, sensory, tactile Role play One-on-one read along stories Learning should be a fun experience Music and rhymes Minimize food additives Positive Approach Offer cheerful encouragement Allow for off days One-on-one with eye contact Gentle pressure on shoulders Use appropriate humor, silliness Repeat, repeat, repeat Practice, practice, practice Adjust your expectations 3

Classroom Success Explain FASD to all students Enlist affected child in peer education Enlist affected child to help when able Establish reasonable goals Close monitoring at all times (1:1) Placement

4 Classroom Success Explain FASD to all students Enlist affected child in peer education Enlist affected child to help when able Establish reasonable goals Close monitoring at all times (1:1) Placement of desk close to teacher Minimize copying from blackboard Modify or minimize homework Use communication log with parents IEP Conflict Resolution Maximize Brain Function Eliminate Additives No food coloring (Red 40) No preservatives (MSG) No nutrisweet (aspartame) Add Vitamins: Daily vitamin (color free) B6, B12 Omega E (fish oil, flaxseed) Lecithin (Choline) Chocolate, turkey, potatoes, bananas Watch Out For Peers who might take advantage of child Peers who are not healthy role models Playground time Cafeteria, locker rooms, gymnasium Before/after school time, between classes School bus (bus aide, sit in front) Defensive, angry parents Adversarial positions: work as a team Greatest Challenges for Teens Behavior problems become more pronounced Physical symptoms are less apparent More than half of adults with FASD have clinical depression. 43% have threatened or contemplated suicide. 23% have attempted suicide. --Streissguth 1996 John with leaf blower John: Self Portrait 4

5 Acceptance and Understanding What Works for Teens and Adults? Music and art Pets and animals 4H and scouts (with supervision) Employment supports Family support groups Mentors Outdoors Physical activities Love works! But love is not enough. Teach Not Learn They may not always remember or understand. They may not be able to apply what they learn. Mom & Daughter We Can Work Together To help individuals with FASD find success Reasonable Plan 5

Teresa s Background. Close Family. Sources. The Faces of FASD. Today We Will Learn About

Teresa s Background. Close Family. Sources. The Faces of FASD. Today We Will Learn About Fetal Alcohol Spectrum Disorders Understanding Effects Improving Outcomes Part 1: The Faces of FASD Presentation by Teresa Kellerman Director of the Fetal Alcohol Resource Center Arizona Division of Developmental