Techniques for Optimizing Success in Identifying and Working with American Indian/Alaska Native Children

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1 Techniques for Optimizing Success in Identifying and Working with American Indian/Alaska Native Children 6 th International Meeting on Indigenous Child Health - Resilience: Our Ancestors legacy, our children s strength Ottawa, Ontario March 20, 2015

2 Candace Shelton, M.S., LISAC (520)

3 Faculty/Presenter Disclosure Candace Shelton has no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity Candace Shelton does not intend to discuss an unapproved/investigative use of commercial product/device in my presentation

4 Potential for conflict(s) of interest Candace Shelton has received payment from the American Academy of Pediatrics [Supporting organization name] [developed/licenses/distributes/benefits from the sale of, etc.] a product that will be discussed in this program: [insert generic and brand name here]. COMPLETION INSTRUCTIONS: Outlines potential conflict between disclosures on slide 1 and your presentation; this slide will be completed by the planning committee.

5 Mitigating Potential Bias The planning committee for [conference name] has deemed there to be no potential for bias or conflict of interest in relation to the speaker(s) declaration(s) and the workshop content. COMPLETION INSTRUCTIONS: This slide will be the same for all faculty who are required to present Slide 2.

6 We Must Acknowledge FASD is Present in Our Communities Awareness educate our women of childbearing age Recognition of the effects of prenatal alcohol exposure cause brain damage Intervention for those women who are addicted, pregnant and need support to stop drinking Treating those affected with respect and provide the support they need to succeed

7 Fetal Alcohol Spectrum Disorders (FASD) Umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy May include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications + Not a diagnosis

8 FASD Facts 100 percent preventable Leading known cause of preventable mental retardation Not caused on purpose Can occur anywhere and anytime pregnant women drink Not caused by biologic father s alcohol use Not a new disorder

9 Cause of FASD The sole cause of FASD is women drinking alcoholic beverages during pregnancy. Alcohol is a teratogen. Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus. IOM Report to Congress, 1996

10 FASD and Alcohol All alcoholic beverages are harmful. Binge drinking is especially harmful. There is no proven safe amount of alcohol use during pregnancy.

13 FASD and the Brain Prenatal alcohol exposure causes brain damage. Effects of FASD last a lifetime. People with an FASD can grow, improve, and function well in life with proper support.

14 FAS and the Brain

Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS and the Brain A B C A B C A.

15 Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P MRI and prenatal alcohol exposure: Images provide insight into FAS and the Brain A B C A B C A. Magnetic resonance imaging showing the side view of a 14- year-old control subject with a normal corpus callosum; B. 12- year-old with FAS and a thin corpus callosum; C. 14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum.

16 FAS and the Brain A These two images are of the brain of a 9-year-old girl with FAS. She has agenesis of the corpus callosum, and the large dark area in the back of her brain above the cerebellum is essentially empty space. Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49 52.

17 How an individual acts determines success or failure Literal thinking Do exactly as told Difficulty with sense of time Difficulty with sense of space Difficulty with recognizing the consequences of their actions Difficulty with managing money Difficulty in level or point systems

18 Diagnosing Fetal Alcohol Syndrome Prenatal maternal alcohol use Growth deficiency Central nervous system abnormalities Dysmorphic features Short palpebral fissures Indistinct philtrum Thin upper lip Source: Astley, S.J Diagnostic Guide for Fetal Alcohol Spectrum Disorders: The 4-Digit Diagnostic Code, Third Edition. Seattle: University of Washington Publication Services, p Caucasian African American

19 Overall Difficulties for Persons With an FASD Taking in information Storing information Recalling information when necessary Using information appropriately in a specific situation

20 Primary Disabilities in Persons With an FASD Lower IQ Impaired ability in reading, spelling and arithmetic Lower level of adaptive functioning: more significantly impaired than IQ

21 Typical Difficulties for Persons With an FASD Are overly sensitive to sensory input Upset by bright lights or loud noises Annoyed by tags in shirts or seams in socks Have problems sensing where their body is in space (clumsy) Do not complete tasks or chores and may appear oppositional Have trouble determining what to do in a given situation Do not ask questions - they want to fit in

22 Typical Difficulties for Persons With an FASD Say they understand when they do not Have verbal expressive skills that often exceed their level of understanding Misinterpret others words, actions or body movement Go off with strangers Repeatedly break rules Do not learn from mistakes or natural consequences Frequently do not respond to point and level systems

23 Typical Difficulties for Persons With an FASD Give in to peer pressure Function unevenly in school, work and development Experience multiple losses Are seen as lazy, uncooperative and unmotivated Have hygiene problems Cannot entertain themselves Have trouble changing tasks Do not pick up on social cues

24 Likely Co-occurring Disorders with an FASD Attention-Deficit/Hyperactivity Disorder Schizophrenia Depression Bipolar disorder Substance use disorders

25 Likely Co-occurring Disorders with an FASD Sensory integration disorder Reactive Attachment Disorder Separation Anxiety Disorder Posttraumatic Stress Disorder Traumatic Brain Injury Risk for Borderline Personality Disorder Medical disorders (e.g.,seizure disorder, heart abnormalities, cleft lip and palate)

26 Possible Misdiagnoses for Individuals with an FASD ADHD Oppositional Defiant Disorder Conduct Disorder

27 Possible Misdiagnoses for Individuals with an FASD Adolescent depression Bipolar disorder Intermittent Explosive Disorder Autism/High Functioning Autism Reactive Attachment Disorder Traumatic Brain Injury Antisocial Personality Disorder Borderline Personality Disorder

28 Paradigm Shift We must move from viewing the individual as failing if s/he does not do well in a program to viewing the program as not providing what the individual needs in order to succeed. Dubovsky, 2000

29 Strategies To Improve Outcomes for Individuals With an FASD Educate the Community Strategies for Sensory Integration Issues Simplify the individual s environment. Provide a lot of one-to-one physical presence. Take steps to avoid sensory triggers.

30 Strategies To Improve Outcomes for Individuals With an FASD Provide one direction or rule at a time and review rules regularly. Use a lot of repetition. Check for understanding Use literal language Teach use of calculators and computers Look for misinterpretations of words or actions and discuss when they occur Use short-term consequences specifically related to the behavior

31 Strategies To Improve Outcomes for Individuals With an FASD Establish achievable goals Provide skills training and use role playing Use first-person language (child with FAS not FAS kid) Address issues of grief and loss Do not blame people for what they cannot do Set the person up to succeed Use a strength based approach, build on the strengths of persons with an FASD

32 Strengths of Persons With an FASD Friendly Sensitive Likable Loyal Desire to be liked Helpful Good with younger children* Determined Have points of insight Not malicious Have a strong sense of fairness Funny and sweet FAS Dubovsky, Drexel University College of Medicine (1999)

33 What the Ancestors Believed LIFE IS SACRED

34 A Well Community Believes PREGNANCY IS SACRED

35 Sacred Gift SLBK

36 Resources SAMHSA FASD Center for Excellence: fascenter.samhsa.gov Centers for Disease Control and Prevention FAS Prevention Team: National Institute on Alcohol Abuse and Alcoholism (NIAAA): National Organization on Fetal Alcohol Syndrome (NOFAS): These sites link to many other Web sites.

SAMHSA FASD Center for Excellence

SAMHSA FASD Center for Excellence FASD FACTS: How You Can Help Prevent Fetal Alcohol Spectrum Disorders FETAL ALCOHOL SPECTRUM DISORDERS The Basics Fetal Alcohol Spectrum Disorders (FASD) Umbrella term describing the range of effects that