EPSE 317

Fetal Alcohol Spectrum Disorder(FASD)

• https://mediamill.cla.umn.edu/mediamill/embed/16409

Some Things FASD is NOT!

• Only found among poverty and certain races.

• Hereditary• An indicator that an affected child’s

mother was a bad person• A guarantee of disaster

One More Thing FASD is NOT

• Quote: “FASD is what I have, not what I am.”

Prevalence

• FASD is now thought to affect between 2 and 5 percent of the school-age population of North America and Europe

• It is much more of an “equal opportunity” disability than is generally acknowledged.

Fetal Alcohol Spectrum Disorder (FASD)

Fetal Alcohol Syndrome (FAS)

Alcohol-related Birth Defects (ARBD)

Partial Fetal Alcohol

Syndrome(PFAS)

Alcohol-related Neurodevelopmental

Disorder (ARND)

(Also called Static Encephalopathy, Alcohol Exposed)

What is FASD?

1. Growth retardation in some of affected population (FAS, pFAS)

2. Facial atypicalities in some of population (FAS, pFAS)

3. Brain damage (FAS, pFAS, ARND)4. Confirmed history of prenatal

alcohol exposure. (almost non-negotiable) (FAS, pFAS, ARND, ARBD)

Four Domains

• Growth – Height or weight (under 10th %ile)

• Face• Brain• Head circumference under 10th %ile• Various areas of brain function• Neurological signs: epilepsy, tremor, tics, etc…

• Alcohol exposure

Diagnosis:

• Diagnosis is multidisciplinary—must involve at least the first two of the following:

• Paediatrician• Psychologist• Optimally, also may include

– Speech-language therapist– Occupational therapist– Physiotherapist– geneticist

Diagnosis in BC

• In BC, a recognised diagnosis must be through a specifically established clinic.

• These exist in regional centres associated with the Provincial Health Authorities, and are called CDBC (Complex Development and Behaviour Conditions) Clinics.

• In addition, a private clinic called the Asante Centre in Maple Ridge does certain assessments.

• See http://www.mcf.gov.bc.ca/fasd/assessment.htm

Facial characteristics

Government of British Columbia, Ministry of Education, Special Programs Branch (1996) Teaching Students with Fetal Alcohol Syndrome/Effects: A Resource Guide for Teachers

FAS FACIAL FEATURES

Colton Harris-Moore

From Clarren, 1978

Alcohol exposure and the brain

Corpus callosum abnormalities

Mattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995

Brain Function

• When psychologists assess a person with FASD, they look at a number of “functional domains.”

• These overlap somewhat, but all contribute to how we understand and identify brain damage which is not visible.

Seven Domains

• Cognition• Adaptation • Executive function • Memory • Communication (Language and a bit

more)• Attention• Achievement

Cognition

• Caution!!! IQ is a very unreliable predictor of functional ability among people with FASD

• Possible exception: very low IQs• IQ can vary from severe intellectual

disability to high average.

Subdomains

• IQ is not a single entity--different areas of intelligence are tested.

• Verbal abilities• Nonverbal abilities• Speed of processing• Working memory

• In most people, subdomains are more or less even

• Among people with FASD, there tends to be a discrepancy among subtest scores.

• Areas of strength don’t necessarily predict other areas. This leads to misunderstandings.

Adaptation: How Does the Person Use Intelligence for

Daily Living?

• Among most of the population IQ and adaptation are pretty much comparable

• Among populations with FASDs, adaptation is much lower than would be predicted by IQ

• It can vary within itself as well.

Executive Function

• The ability to organise one’s skills. Planning, working memory, organisation, inhibition, initiation…

• The ability to evaluate one’s own behaviour and change in response to that evaluation. (self-regulation)

Executive functions

• Sequencing and planning—how to initiate a task, what steps are involved in completion, when to quit

• Flexibility-how to shift tasks smoothly, accept change, deal with transitions

• Impulse control—• The ability to keep one’s self and materials

organized, in order, predictable, etc.

Also related to EF

• Working memory. Holding information in mind while performing action on it.

• Attention: Maintaining and switching attention, distractibility.

• Motor control and sensorimotor processing• Overly concrete language.

Memory

• Not a single factor• Short-term/long-term/working memory• Storage/retrieval• Verbal/nonverbal• Abstract/concrete• Procedural memory• “Norbert’s memory is just fine--he always

remembers when we’re going to the movies!”

• Memory can be intermittent—here today, gone tomorrow– Reteach, keep calm– Look for multi-tasking—is the situation

the same as it was yesterday? In what respects?

– Implications regarding generalisation– Implications regarding use of

consequences to change behaviour

Communication

• Language impairments are very common among alcohol-affected children and adults.

• They are often very talkative.• Expressive language is often apparently

more developed than receptive language.

• “Norbert is so controlling! Everything has to be his way..conversation topics, play, routine…”

Why is Norbert so controlling?

• What happens if you lack receptive language?

Communication is a Biggie--More

• Psychological testing may not be sensitive enough to identify language problems

• SLP can identify subtle but treacherous areas of weakness

• 110 km highway with huge potholes here and there

• Understanding language important to understand behaviour and learning in addition to possibly indicating Speech-language therapy.

Communication is More Than Language

• Pragmatics--how language is used• Nonverbal cues• Language as social interaction--initiating

contact, ending contact, turn-taking.• Problem solving--inference, “why”

questions, prediction

Attention/Activity Level

• Often a problem• FASD and ADHD can coexist• Or attentional difficulties can be a

part of the brain damage of FASD• Sometimes but not always

responsive (but not entirely) to medication.

Achievement• Academic achievement can be

misleading• Students can have limited ability to

generalise• Not necessarily a predictor of skills

beyond the classroom• Lots of challenges to achievement

posed by the issues we’ve covered• Investment of time and energy to

meeting curriculum requirements may be controversial.

Some Effects of Brain and Central Nervous System

Damage(mostly)

…and some hints about what to do about them

Vision

• Visual impairment (poor eyesight)

And/or

• Visual perception

What to do? Try:

• Provide a visually quiet space for learning.

• Look from student’s eye level for distractors

• Keep one thing on desk at a time• Look for students’ own strategies

(hoodies, baseball hats)

Lighting

• Florescent lights can be a problem both visually and auditorially.

• Try for natural light (good luck in Vancouver!)

• Incandescent lighting tends to be better.

Hearing impairments

• Can be either problems of acuity or perception.

• Hypersensitive hearing (hyperacousis) is common.

• Otitis media (glue ear).

Hearing impairments

• Can be either problems of acuity or perception.

• Hypersensitive hearing (hyperacousis) is common.

• Otitis media (glue ear).

Try:

• Listen for distracting noises-– Gurgling fish tank– Hallway noise– Lights or screens buzzing– Plumbing

• Warn before fire drills• Find other way of getting class attention

than: “clap, clap, clap clap clap.”• Watch for signs of auditory distress, in gym,

music, etc.• Consider use of headphones or earbuds.

Hypersensitivity(over-sensitivity)

• Children may be very uncomfortable with being touched or held

• Toothbrushing can be a real battle• Certain foods (temperature or texture) can

be very distressing• Textures of fabric in clothing can be

distressing.• Children can’t explain what’s troubling

them.

Cautions:

• Don’t touch child without his/her knowing you’re about to.

• Be aware of smells, including “coffee breath,” perfume, scented felt tips, etc.– ICK! You don’t smoke, do you?

• Exercise tolerance re: refusal to wear socks, etc.

• Note that this can result in over-reactions to slight touch in hallway—organise time accordingly

Hyposensitivity(Under-sensitivity)

• Dangerously high pain threshold• Insensitivity to extremes of hot and cold• May seek physical stimulation and

feedback by touching or banging on things• May sniff things, people• Find socially acceptable ways for student

to meet sensory needs

Cautions

• Hyper- and hypo- can coincide• Interpret sensory seeking behaviour

as such rather than aggression or sexual acting out

Students may mature at uneven rates:

• Chronological age: 15• Expressive language of a 17-year old• Receptive language of a 7-year-old• Social judgement of a 6-year old• Gross motor abilities of a 15-year old• Reading (decoding) of a 12-year old• Reading comprehension matching

receptive language

Reading

• Essential skill• Most kids with FASD can learn to

read• Comprehension can be an issue• Reading as a support for memory

– Lists– Labels– ??

Math

• Best approached as applied skill• Cooking• Use of supermarket flyers for

shopping• Teach time very directly

Visual Timer

• Time as sequence of events rather than duration:– “After lunch,” rather than “in an hour.”– First math, then recess…

Teach transitions explicitly

– Limitations of episodic visual schedules

Social Safety

• Minimal or no stranger awareness• Optimally, keep student occupied

and observed• Try social safety circles, but don’t

rely on them exclusively• Uneven maturation can be a big

issue

It’s not easy…

• It’s less difficult than attempts at reactive behavioural change.

• It’s more productive and cost-efficient in the long run.

• It’s ethically the right thing to do.• It’s worth it--students with FASD can

grow into contributing members of society.

• Education is all about hope.

http://findinghope.knowledge.ca/fullscreen3.html