LEARNING ABOUT FASD A TEACHING PACKAGE FOR POST-SECONDARY INSTITUTIONS

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Isabella Woods
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1 LEARNING ABOUT FASD A TEACHING PACKAGE FOR POST-SECONDARY INSTITUTIONS

2 Acknowledgements This presentation was developed by the Saskatchewan Prevention Institute with the guidance of the Alcohol Risk Assessment Phase II Project Advisory Committee. Funding was provided by the Saskatchewan Ministry of Health. The Saskatchewan Prevention Institute is a non-profit organization that has been in place for over 25 years. Their Mission is to reduce the occurrence of disabling conditions in children. The Saskatchewan Prevention Institute focuses on Primary Prevention. They do this by providing: Education Information Services Community Development Research and Evaluation Communications Program Areas include: Alcohol, Tobacco, and Other Drugs Childhood Injury Prevention Perinatal and Infant Health Parenting Education Community Development Youth Sexual Health

3 Values, Attitudes, and Stereotypes

4 Personal Feelings It is normal to experience a number of feelings when talking about FASD. They may include feelings of confusion, anger, shame, questioning, or affirmation.

5 FASD is a Sensitive Topic Society views women who use alcohol during pregnancy in a negative manner. (Burgoyne, 2005)

6 Values Values are the basic rules of all societies, interpreted in the context of the culture in which they are held. Important to recognize and understand personal values.

7 Making Judgments When you judge others, you do not define them, but define yourself. Dr. Wayne Dyer

8 What Can You Do? Hope Cooperation Respect Compassion Understanding

9 What is FASD?

10 Fetal Alcohol Spectrum Disorder FASD is a lifelong disability caused by maternal alcohol use during pregnancy. Prenatal alcohol exposure can cause a range of disabilities. Often referred to as the invisible disability. (Chudley et al.,2005)

11 FASD is an Umbrella Term Fetal Alcohol Syndrome (FAS) Partial Fetal Alcohol Syndrome (pfas) Alcohol-Related Neurodevelopmental Disorder (ARND) (Chudley et al.,2005)

12 FASD is preventable, but not 100% FASD occurs only when the mother consumes alcohol during pregnancy. (Chudley et al., 2005) Many factors influence a woman s alcohol use during pregnancy. (Dell & Roberts, 2005)

13 How Common is FASD? Leading known cause of developmental disability in North America. (Poole, 2008) In Canada it is estimated that 9 in 1000 (approx. 1 in 100) babies will be born with FASD. (Sampson et al., 2007)

14 FASD and the Aboriginal Population History of residential school and colonization. (First Nations, Inuit, and Aboriginal Health, 2007) Experience high rates of FASD in relation to loss of family connections and culture and not because of any racial or cultural characteristics. (Wemigwans, 2008)

15 FASD and the Aboriginal Population Disproportionate amount of research in Canada on Aboriginal women s use of alcohol during pregnancy focusing on communities with known high rates of alcohol and substance use. (Masotti et al., 2003, Tait, C., 2004) Results are then generalized to general population. (Tait, C., 2004)

16 Alcohol, Women, and Pregnancy Self-Reflection on Personal Alcohol Use

17 Alcohol Use in Canada Societal Norm. Alcohol is the most abused legal or illegal substance in Saskatchewan and Canada. (Saskatchewan Executive Council, 2007) 76.8% of Canadian women and 82% of Canadian men over the age of 15 drink alcohol at some point. (Canadian Executive Council on Addictions, 2008; National Alcohol Strategy Working Group, 2007)

18 Standard Drink Size 4 oz Wine 12 oz Beer 1.2 oz Liquor X 12% alcohol X 4% alcohol X 40% alcohol.48 oz pure alcohol.48 oz pure alcohol.48 oz pure alcohol

19 Binge Drinking Considered to be 5 standard drinks for men and 4 standard drinks for women per occasion. Youth are more likely to binge drink compared to adults. (Statistics Canada, 2003)

20 Drinking and Pregnancy Approximately 14% of women drink during pregnancy (based on self reporting). (McCourt, Paquette, Pelletier & Reyes, 2005) Pregnancy is often a motivator to stop drinking alcohol. (Alberta Alcohol & Drug Abuse Commission, 2004)

21 Drinking and Pregnancy Unintended pregnancy rate in Canada is approximately 40%. (McCourt, Paquette, Pelletier & Reyes, 2005) 72.8% of women between the ages of 18 to 44 years consumed alcohol in the past year. (Alberta Alcohol and Drug Addictions Commission, 2004)

22 Who s at Risk? ALL women of childbearing age who consume alcohol are at risk of having a child with FASD. (Dell & Roberts, 2005)

23 High Risk Group: Career Women Women in their 30 s, high education, high income. (Alberta Alcohol & Drug Abuse Commission, 2004; Muhajarine, D Arcy, & Edouard, 1997) In Alberta 40.5% of women who earn $80,000 and more annually report drinking alcohol during pregnancy. 23.1% of women who earn between $60,000 to $79,999 annually report drinking alcohol during pregnancy. (Alberta Alcohol & Drug Abuse Commission, 2004)

24 High Risk Group: Marginalized Women Women who are loneparenting, living in poverty, have children in custody, struggle with addictions, have low self-esteem, history of abuse. (Vaillencourt & Keith, 2007; Koehn, 2008)

25 High Risk Group: Youth In Canada: 82.9% of youth over the age of 15 had consumed alcohol within the last year. (National Alcohol Strategy Working Group, 2007) Pregnancy rates for youth younger than 20 years is 24.6 per 1000 births. (Statistics Canada, 2005)

26 Social Determinants of Health Each determinant is important on its own but is also interdependent on the others. Determinants of health may affect a woman s choice but do not dictate them. (Public Health Agency of Canada, 2003; Wilkinson & Marmot, 2003)

27 Social Determinants of Health Income/Social Status Social Support Networks Education/Literacy Employment/ Working Conditions Social Environments Physical Environments Personal Health Practices/Coping Skills Healthy Child Development Biology/Genetic Endowment Access to Health Services Gender Culture (Public Health Agency of Canada, 2003; Wilkinson & Marmot, 2003)

28 Why Do Pregnant Women Drink Alcohol? Pregnant Women Peer Pressure Unstable Housing Addiction Poverty Children in Custody Low Self-Esteem Violence and Abuse Low Education Shame Mental Health Issues

29 Youth and Alcohol Use

30 Youth Youth is defined as persons aged years of age. (National Alcohol Strategy Working Group, 2007) On average, youth begin drinking at age 15. (National Alcohol Strategy Working Group, 2007) Brain continues to develop throughout adolescence. (Paus, 2005; Giedd et al., 1999)

31 Rates of Alcohol Use Canadian Youth and Alcohol Consumption Behaviour % of Youth Reporting the Behaviour Consumed alcohol in the last year 82.9% Consumed 5 or more drinks each time 33.7% Consumed alcohol heavily at least once a week Consumed alcohol heavily at least once a month 13.9% 46.0% (National Alcohol Strategy Working Group, 2007)

32 Alcohol Use and Gender Historically, males drank more alcohol than females, however this is changing. (Wechsler, Lee, Kuo, Seibring, Nelson, & Lee, 2002) Females between ages of 15 to 19 surpass their male counterparts in alcohol use. (Canadian Centre on Substance Use, 2004) Approximately 80% of female undergraduate students drink alcohol. (Canadian Centre on Substance Use, 2004)

33 Youth, Alcohol and Pregnancy Unprotected sexual activities are strongly linked to alcohol use. (Canadian Pediatric Society, 2006) Pregnancies among Canadian youth is decreasing although the rates remain high. (Statistics Canada, 2005) Saskatchewan youth pregnancy rates are higher than the national average. (Statistics Canada, 2005)

34 Adolescent Pregnancy Rates in Canada Age Group Younger than 20 years Canadian Rates Saskatchewan Rates 24.6 per per to 19 years 59.0 per per to 17 years 15.8 per per 1000 Younger than 15 years 01.9 per per 1000 (Statistics Canada, 2005)

35 Support For Women Who Drink During Pregnancy

36 Personal Supports Can influence a woman s drinking in a positive or negative manner. (Gearing et al., 2005) Can influence society at a broader level as a member of the community to address issues that influence women s alcohol use (e.g., poverty, housing). (Gearing et al., 2005)

37 Harm Reduction Harm reduction is: any program, policy or intervention that seeks to reduce or minimize the adverse health and social consequences associated with drug and alcohol use without requiring an individual to discontinue drug or alcohol use. (Beirness, Jesseman, Notarandarea & Perron, 2008, pp. 2)

38 Harm Reduction Philosophy Based on individual needs. Allows care providers to meet the individuals where they are at. Builds on successes to reduce use and improve health. (Alberta Non-Prescription Needle Use Consortium, 2000)

39 Harm Reduction Key Principles Pragmatism Humane Values Focus on Harms Balancing Costs and Benefits Priority of Immediate Goals (Beirness et al. (2008)

40 Alcohol Risk Assessment Asking about alcohol can provide a context for: Education about alcohol use. Identification of the woman s alcohol use. Discussion of the possibility of change. Referral to appropriate programs or treatments. (Saskatchewan Prevention Institute, 2007)

41 Alcohol Risk Assessment Ask, Advise, and Assist

42 Alcohol Risk Assessment T-ACE Tool

43 Motivational Interviewing Motivational Interviewing is: a directive, client-centered counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence. (Saskatchewan Alcohol and Drug Services, 2006, pg. 35)

44 Motivational Interviewing Principles Express Empathy. Develop Discrepancy. Roll with Resistance. Support Self-efficacy. (Venner, Feldstein & Tafoya, 2006; Saskatchewan Prevention Institute, 2007)

45 Stages of Change Relapse Permanent Exit Precontemplation Maintenance Contemplation Action Determination (Adapted from Miller et.al., 1994; Miller & Rollnick, 1991; Prochaska, 1984)

46 Impact of Alcohol on Fetal Development

47 What is a Teratogen? A Teratogen is: environmental substance that interferes with the normal development of the fetus, causing fetal death or congenital abnormalities. (University of Virginia, 2006)

48 Alcohol is a Teratogen Alcohol causes damage to the central nervous system (brain). (Chudley et al., 2005) Alcohol is a neurobehavioural teratogen. (Chudley et al., 2005) Alcohol can also damage other parts of the developing fetus. (Chudley et al., 2005)

49 Paternal Alcohol Use Sperm may be affected by alcohol and other drugs. (Gearing et al., 2005) Behavioural attributes have been associated with paternal exposure to alcohol. (Cicero et al., Tanaka, Suzuki, & Arima, 1982) FASD is not a result of paternal alcohol use.

50 Contributing Factors The amount or pattern of alcohol use. Genetics of the mother and the baby. The developmental stage of the fetus. Other influences such as nutrition, medical care, and drug use. (Berk & Shanker, 2006)

51 Fetal Development First Trimester 0-12 Weeks 0-3 Weeks Zygote 3-9 Weeks Embryo 9-12 Weeks Fetus Second Trimester Weeks Fetus Third Trimester Weeks Fetus

52 First Trimester First Month: Heart, lungs, limbs, face, ears, eyes, spinal cord, and brain begin to form. Second Month: Toes and eyelids form; brain grows quickly and controls body movements. Third Month: Most major organs and the face are developed. Bones continue to grow and kidneys start to work. (Bolane, 1991)

53 Second Trimester Fourth Month: The placenta is fully formed and fetal movement may be felt by the mother. Fifth Month: Eyelashes, eyebrows and scalp hair appear. Fetal heartbeat can be heard. Six Month: Eyes open and close. Lungs, brain, and other organs continue to develop. (Bolane, 1991)

54 Third Trimester Major organs mature to support life. Fetus grows quickly in weight and length. (Bolane, 1991)

55 Remember The brain continues to grow and develop throughout pregnancy and is always vulnerable to alcohol. (University of Virginia, 2006)

56 How Alcohol Passes to the Fetus

57 Impact of Prenatal Alcohol Exposure Cellular Level Decrease number of cells. Interferes with: Proliferation: how the cells grow Migration: where the cells go Neurotransmitters: how the cells communicate

58 Impact of Prenatal Alcohol Exposure Neurological Level Alcohol directly affects brain size, structure, and function. Brain damage persists throughout the lifespan.

59 Impact of Prenatal Alcohol Exposure These are images of two brains for 6 week old babies. The one on the right was severely affected by alcohol (to the extent that the infant did not live).

60 Impact of Prenatal Alcohol Exposure Physical Level Alcohol can affect the whole body Growth Facial features Eyes, ears, teeth Muscular-skeletal Internal organs Genitals/urinary system

61 Referral and Diagnosis

62 How to Refer More than writing a letter or making a phone call. Need to build a trusting relationship before approaching the individual/family about the possibility of diagnosis. Need individual s/family consent. (Chudley et al., 2005; Wemigwans, 2008)

63 When to Refer Scenario 1 Scenario 2 Scenario 3 Scenario 4 Scenario 5 Presence of the three facial characteristics of FASD Presence of at least one of the facial characteristics of FASD Presence of at least one of the facial characteristics of FASD Presence of at least one of the facial characteristics of FASD Known/probable prenatal exposure to alcohol Known/probable prenatal exposure to alcohol Known/probable prenatal exposure to alcohol Known/probable prenatal exposure to alcohol Growth deficits Growth deficits Central nervous system deficits Central nervous system deficits (Chudley et al., 2005)

64 When to Refer Note: Individuals with learning or behavioural difficulties, or both, without physical or dysmorphic features and without known or likely prenatal alcohol exposure should be assessed by appropriate professionals or specialty clinics to identify and treat their problems. (Chudley et al., 2005, pg S5)

65 Diagnosis Diagnosis of an FASD is complex. Uses a multidisciplinary team approach. FASD: Canadian Guidelines for Diagnosis. Four key areas assessed. (Chudley et al., 2005)

66 Diagnosis Source: Leja, Darryl - Characteristic Facial Features in a Child with Fetal Alcohol Spectrum Disorder, National Human Genome Research Institute, National Institutes of Health, Bethesda, Md.

67 Assessment Process Screening and Referral Physical Examination and Differential Diagnosis Neurobehavioural Assessment Follow-Up and Support (Chudley et al., 2005)

68 Benefits of Diagnosis Helps improve outcomes for the individuals. (FAS/E Support Network of BC, 2002) Helps families, providers and communities work with the individual. (FAS/E Support Network of BC, 2002)

69 Negative Consequences of Diagnosis Feelings of shame and guilt especially for the birth mother. Stigmatization of the individual who is diagnosed. Having to admit that there is something wrong or different about their brain and/or body. (Chudley et al., 2005; Wemigwans, 2008)

70 Primary and Secondary Disabilities

71 Primary Disabilities Occur as a result of damage to fetus before the individual is born. (FASD Support Network of Saskatchewan, 2007) Impact the cognitive, behavioural, and physical/sensory functioning of the individual. (FASD Support Network of Saskatchewan, 2007)

72 Cognitive Impairments Refers to intellectual processes and mental tasks. Areas of difficulty include: Lower IQ (Rasmussen, Horne & Witol, 2006) Conceptual and abstract thinking (Mattson & Roebuck, 2002; Saskatchewan Learning, 2004; Schonfeld, Mattson, Lang & Delis, 2001)

73 Cognitive Impairments Cause and effect reasoning (Burden, Jacobson, Sokol, & Jacobson, 2005; Carmicheal Olson, Morse & Huffine, 1998; Saskatchewan Learning, 2004) Generalization (Burden et al., 2005; Kodituwakku, Kolberg & May, 2001; Schonfeld, Mattson, Lang & Delis,2001) Time (Saskatchewan Learning, 2004) Memory (Mattson, Goodman, Caine, Delis & Riley, 1999; Mattson & Roebuck, 2002; Saskatchewan Learning, 2004)

74 Behavioural Function Behaviour is related to social and emotional development. Areas of difficulty include: Interpersonal skills (Carmicheal Olson et al. 1998a) Reading social cues (Carmicheal Olson et al., 1998a) Impulsive actions (Saskatchewan Learning 2004) Emotional regulation (FASD Support Network of Saskatchewan Inc., 2007) Rigid and inflexible behaviour patterns (Rasmussen et al., 2006) Over-activity/attention problems (Rasmussen et al., 2006) Dysmaturity (Malbin, 2007)

75 Physical and Sensory Function The sensory system allows the individual to take in information about their surroundings. Physical development includes growth of the entire body, sensory system, and motor development.

76 Physical and Sensory Function Areas of difficulty include: Delayed motor development (Matson & Riley, 1998) Poor motor control (Chudley et al., 2005) Lower weight and height (Chudley et al., 2005) Hearing impairments (Saskatchewan Learning, 2004) Auditory processing problems (Rasmussen et al. 2006; Saskatchewan Learning, 2004) Damage to various systems (e.g., skeletal) (Saskatchewan Learning, 2004) High or low pain tolerance (FASD Support Network of Saskatchewan Inc., 2007) Sensitivity to light, sound, texture, or stimulation (Saskatchewan Learning, 2004)

77 Secondary Disabilities Mental health problems Disrupted school experiences Easily victimized Trouble with the law Inappropriate sexual behaviour Alcohol and drug problems Problems with employment and living independently (Streissguth, 1997)

78 Protective Factors Living in a stable, nurturing home for most of life Staying in the same household for at least 3 years Not being a victim of violence Receiving services for disability Diagnosed by 6 years of age (Streissguth, 1997)

79 Strengths Individuals with FASD have many strengths. Strategies or accommodations for the individual with FASD should be built on their strengths. (Malbin, 2002)

80 Strategies/Accommodations Everyone is different. Strategies need to be individualized. Focus on who the person is and what their strengths and needs are. (Malbin, 2002)

81 Prevention of FASD

82 Prevention Four levels of prevention: Raising awareness Risk assessment Providing interventions, treatment, and other assistance to pregnant woman Continued support for women after the baby is born (Poole, 2008)

83 Prevention Effective Strategies: Take the level of readiness of the community into account Address the root causes of alcohol use Build on existing strengths (FAS/FAE Technical Working National Steering Group, 2001)

84 FASD and the Media

85 Conflicting Messages There are conflicting messages about safe levels of alcohol consumption. (Gijsen et al., 2008) It is safest to avoid alcohol during pregnancy. (Public Health Agency of Canada, 2008)

86 For More Information, Contact: The Saskatchewan Prevention Institute 1319 Colony Street Saskatoon, SK S7N 2Z1 Bus Website:

Understanding Prenatal Alcohol Exposure

Understanding Prenatal Alcohol Exposure Prenatal Alcohol Exposure Causes Birth Defects Alcohol and pregnancy do not mix. Slide 2 The U.S. Surgeon General s Warning The dangers of consuming alcohol during