YES!! Can Children with FASD Learn? Overview. Math Interactive Learning Experience MILE. intervention research. Target Population

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1 How to Help the Child with FASD Develop the Underlying Cognitive Skills Needed for Success in Math: the MILE PROGRAM Elles Taddeo, EdD Emory University, School of Medicine Department of Psychiatry Atlanta, GA Taking the Next Step: Innovative Interventions for FASDs Atlanta, October 21, 2010 Can Children with FASD Learn? YES!! Overview Brief overview of the MILE Math intervention study Neurodevelopmental problems that impact on learning How to help build cognitive and math skills through Interactive Learning Math Interactive Learning Experience MILE The Study FAS Intervention Research Although the research on the teratogenic effects of prenatal alcohol exposure began in the 1970 s, treatment research in this area is in its infancy The MILE study is part of a multi-site study (1 of 5) initiated by the CDC to facilitate FAStargeted intervention research Target Population Children between the ages of 3-10 years of age with a Dx of FAS or pfas Have been with one caregiver for 6- months and projected to remain with that caregiver for the next 6-months No other major diagnoses (e.g. Autism, Down Syndrome)

2 The Math Intervention Group ½ of the children and caregivers got math intervention 6 week program 1 on 1 tutoring interactive learning MILE program Components of the Math Intervention Caregiver training Manual regarding math development and FAS Individual discussion regarding implementation of home math stimulation activities Child tutoring 6 week IEP developed using curriculum 6 week 1 on 1 tutoring sessions Teacher training Manual regarding FAS Discussion regarding child s neurodevelopmental profile Discussion regarding our 6-week IEP Sample Curriculum Page Sample Parent Handout Math Outcomes at Post Tests 1 and 2 Clinically Significant Gains Math Tutoring n=29 No Math n=26 Post 1 Gain 58.6% 23.1% Predictors of Treatment Gain Younger child Younger caregivers More adults More children Post 2 Gain 64.3% 38.5% No effect: gender, television viewing time, neurocognitive status, household income.

3 What are the Neurodevelopmental Problems that Impact on Learning for Children with FASD? Though general learning ability is affected in children with Fetal Alcohol Syndrome, learning can be improved! Specific Problems Memory especially working memory Visual/spatial processing Graphomotor or Visual-Motor Skills Attention and arousal problems Memory Understand today Forget tomorrow Able to do it in the morning Not anymore in the afternoon Not paying attention??? NO, this is a memory problem! Frayed cord analogy If the neuronal connections are not strong, the memory may shoot into a different area and cannot be retrieved just like electricity through a frayed cord x manifest ZPD Far out Creating strong memory pathways requires repetition, repetition, repetition.

4 Working Memory Working Memory (cont d) Working Memory is used for Hold information of the task Remember where you are in the task Remember what you are doing Copy information from the board What was I supposed to do again..? Problems in Working Memory cause: * Difficulty copying * Difficult to understand multi-step directions * Difficulties in using a calculator * Difficulties with organization??? Supports for working memory deficits in the area of math Visual Spatial Ability Especially in math it is very important to be able to see and understand spatial relationships or or?? If a child has deficits in this area, then all future math development may be compromised Visual spatial problems may cause Left or Right? Lose place on worksheet Confuse numbers Confuse coins Confuse up-down and left-right Aligning numbers Problems understanding time Up or Down? 6 or 9? 23 or 32? Graphomotor Skills Sloppy writing Poor organization on paper Numbers crowded and messy Often the act of writing may interfere with the thinking process What s 5 minutes? Is this a nickel? A dime?

5 Handwriting w/o Tears Materials Attention and Arousal Problems Different from ADHD Difficulty with shifting attention These children will need minute warnings when time s up This is NOT willfully not paying attention (most of the time!) How to get around the neurodevelopmental problems and help the child develop math and cognitive skills? Interactive Learning Overview What is Interactive Learning? How is cognition taught? Why do cognitive skills fail to develop? Essential ingredients of Interactive Learning Why Interactive Learning? Children learn in two ways Direct exposure Through interaction (mediation) Children with FASD do not learn well through direct teaching (passive learning) They need interaction with others and with objects in order to learn skills that seem to just happen in typical children. Everyone repeat after me: = = = 4 How much is 2 + 2?

6 Where does Interactive Learning Start? Being able to learn through direct exposure is a LEARNED BEHAVIOR. E.g. children learn to focus on what is important by having things pointed out to them. Most parents naturally interact with their children. Through these interactions children develop underlying cognitive skills. If a child does not get sufficient interaction his/her cognitive skills will be affected. How is Cognition Taught? How is Cognition Taught? Scenario walk in the park: Look at the dog Look at the dog s tail His tail is wagging That means he is happy When you are happy you smile Look, another dog. He is happy too, how can you tell? Remember, just like the big dog we saw before. Maybe we will see another one when we go to the store Look at the dog Look at the dog s tail What is taught? - Attention and focusing -Clear perception - Narrowing the focus to that which is important - Ability to pay attention to relevant information How is Cognition Taught? How is Cognition Taught? His tail is wagging That means he is happy When you are happy you smile What is taught? - Naming an event - Meaning -New Information - Apply new information to another situation - Make connections Look, another dog. He is happy too, how can you tell? Remember, just like the big dog we saw before. Maybe we will see another one when we go to the store What is taught? - Reinforcing earlier learning - Logical evidence - Hypothetical (abstract) thinking - Connect past, present and future to give a sense of continuity and understanding of cause and effect -Comparing - Making connections between events

7 Why do Cognitive skills Fail to Develop? Insufficient Interaction Interaction not offered Typical Child Child is not open to benefit from interaction Child with FASD Insufficient Interaction Not offered Environmental (e.g. orphanage) Socio-economic status Parents do not have enough time Not open to Genetic factors (e.g. Down s) Brain damage (FASD) Emotional factors Children with FASD Need Increased Mediated Levels of Interaction Problems with specific Cognitive Skills in Children with FASD Many children with FASD have difficulty with: attending to relevant information taking in more than 2 pieces of information accurate and complete data gathering recognizing a problem systematic exploration spatial orientation INTERACTIVE LEARNING HOW TO These are skills that can be learned

8 Interactive Learning: Essential Ingredients Choice Planning and Metacognitive Questioning Prompting Praise Choice Within the context of the learning situation, the child has a choice No open-ended choices No Yes-No choices Planning and Metacognitive Questioning Child and adult talk about what is going to happen, is happening and what has happened Before, during and after the task Adult encourages child s intentions, reflections, problem solving, and creativity The MILE Way of Learning F-A-R Focus and plan Act Reflect Metacognitive Questioning The purpose of questioning is to help the student become aware of his/her own thinking Therefore, ask PROCESS questions Ask for justification of both RIGHT and WRONG answers Why-Question the answer will be I don t know! CHANGE THE QUESTION. Genuine I don t know! Help the student by prompting Why did you write 4? I don t know! I just did. That s the right answer! What did you do to get it? I counted my fingers. Prompting in Interactive Learning Give the student the opportunity to show what he/she knows Use the 10-second-rule Start prompting farthest away What do you think you need to do here? The instructions say I need to add the numbers Far prompting Based on Feuerstein s Mediated Learning Experience theory Based on Feuerstein s Mediated Learning Experience theory

9 Prompting in Interactive Learning If the student truly does not know, move in as close as is needed to make him/her respond successfully Move closer by little steps at a time Allow the child to give the answer, even with an extremely close prompt Praise Experience success maybe learning is fun? A nine! What is this number? A nnn.. Very good! A nine. Close prompting Genuine Praise Metacognition: Praise the behavior Good Job this does not tell the child anything Good Thinking! Nice Straight Lines! You compared these two and you found the answer! Based on Feuerstein s Mediated Learning Experience theory No Yes Good boy! You did a good job today! Really? What did I do? You sat quietly and listened to me all the time. Well done! Praise Yes Yes Your 2 s are looking real good! I m glad I practiced so hard yesterday! RECAP we talked about: Results of the MILE Math Study Specific problems that impact on learning Interactive learning Yessss! I am getting much better at listening Great job focusing on your math! Count one more time. Are you sure 5 is the right answer? QUESTIONS?