Working with kids with Fetal Alcohol Spectrum Disorders (FASD)

Working with kids with

Fetal Alcohol Spectrum Disorders

(FASD)

MN Organization on Fetal Alcohol Syndrome 2

FASD Timeline

Feb 2013


US Map– Centers for Disease Control, 2010

Feb 2013

Minnesota Pregnancy Drinking Statistics

• Almost half of pregnancies are unplanned (contraception failure or lack of use), 28% of births are unplanned. (Henshaw, 1998)

• 20% of pregnant women continue to drink after finding out they are pregnant. (Stratton et al 1996)

• In MN, about 12% of women consume five or more drinks per month during pregnancy. (Taking A Closer Look MDH 2002)

• In MN, about 5% binge-drink (5 or more drinks at a time) during pregnancy. (Taking A Closer Look MDH 2002)

MN Organization on Fetal Alcohol Syndrome 4Feb 2013

What are the facts?

• Alcohol use during pregnancy does not always result in FASD

• Most children with FASD go undiagnosed


An Under-Identified Disorder

• More Common than Autism • Leading cause of intellectual

disability in North America• FASD occurs in all racial,

ethnic and socioeconomic groups

• Often misdiagnosed due to lack of information and awareness

(See Overlapping Characteristics)• DSM barrier• 100% Preventable


Incidence of fetal alcohol spectrum disorders– Minnesota Statistics - CDC 2006; National Statistics - March of Dimes; NOFAS 2004.

Down's Syndrome

Cerebral Palsy

Spina Bifida

FASD0

2

4

6

8

10

12

1.25

3

1

10

Prevalence of Birth Defects Per 1,000 Live Births

Feb 2013

What are Fetal Alcohol Spectrum Disorders

(FASD)? • A set of physical, behavioral, and cognitive

disorders seen in individuals exposed to alcohol prenatally

• Lifetime disability with brain injury that never goes away

• Broad range (spectrum) of characteristics that vary from person to person



The FASD UmbrellaFetal Alcohol Spectrum Disorders

Fetal Alcohol Syndrome (FAS) Partial Fetal Alcohol

Syndrome (pFAS)

Fetal Alcohol Effects (FAE) replaced by ARBD & ARND in 2006

Alcohol-Related Birth Defects

(ARBD)

Alcohol-Related Neurodevelopmental Disorder (ARND)

Feb 2013

Areas of Diagnostic Evaluation

1. Facial Dysmorphia

2. Growth Problems

3. Central Nervous System Abnormalities

4. History of Maternal Alcohol Exposure



FAS Facial Characteristics

Thin upper lipPalpebral fissures

Smooth, long philtrumCDC 2004Might also have: Low set ears, flat mid-face, up-turned nose, small chin, and epicanthal folds.

FAS Facial Characteristics – Image courtesy of FASTAR..

Feb 2013

FASD & the Brain


National Organization on Fetal Alcohol Syndrome (NOFAS), 2004; Adapted from Moore, 1993.

Feb 2013

Newborn Brain


Brain Damage• Failure of certain brain regions (e.g., the

corpus callosum) to develop• Failure of certain cells to migrate to their

appropriate locations during embryonic brain development

• A tendency for the tissue to die in some brain regions (e.g., the cerebellum)


Winter 2000 issue of Alcohol Research & Health

Feb 2013


Prenatal exposure to alcohol causes permanent

brain injury that never goes away.

Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52.

Feb 2013


Most Affected Areas of the Brain

Feb 2013

Corpus Callosum• Attention

• Intellectual function

• Executive functioning

• Learning


Cerebellum• Movement, motor control• Balance & equilibrium • Muscle tone• Ability to judge distances• Involved in some cognitive processes


Basal Ganglia• Can affect spatial memory and behaviors

– Perseveration– inability to switch modes– work towards goals– predict behavioral outcomes

• Time perception


Frontal Lobes• Impulse control

• Self regulation

• Executive Functions-– Linking 2 or more ideas together– Understanding abstract or complex concepts – Generalizing (ex. Learning to cross street)– Understanding cause & effect / consequences– Judgment


Prenatal Alcohol Exposure and Information Processing


• input (taking information in from the senses)

• integration (interpreting information, making sense of it)

• memory (storing information for later use, connecting with previous experiences)

• output (response, behavior)

Feb 2013

Look at the chart and say the color not the word

YELLOW BLUE ORANGE BLACK RED GREENPURPLE YELLOW REDORANGE GREEN BLACK BLUE RED PURPLE

LEFT-RIGHT CONFLICTYour right brain tried to say the color but your

left brain insists on reading the word.


Strategies

Sensory Processing• What is it exactly?• Taking in and

making sense of incoming data

• Having an appropriate response to the data received

MN Organization on Fetal Alcohol Syndrome 24Spring 2013

Problems with Sensory Processing

Under Responsive• Excessive need to touch• Spinning• On the move• Floppy• Likes swinging• Crashing• Roughhousing• Limited body space

awareness

Over Responsive• Avoids touch• Struggles when picked up• Aversion to play dough• Doesn’t like hair comb• Doesn’t like barefoot• Doesn’t like playground

equipment• Doesn’t like feet not on the

ground


Intervention Strategy Ideas• Calm and Quiet

environment• Limit number of

objects on walls and hanging

• Calm Colors on Walls• Define Spaces (eating,

playing, resting)• Establish rules for

cleanup and transition


Intervention Strategies• Quiet routine activities

to help stay organized• Sing small songs to

help with routine activities

• Focus on cause and effect activities

• Increased language stimulation activities

• Set limits


http://www.books-for-babies.com/wp-content/uploads/2010/04/Fun-Books-For-Babies.jpg

Intervention Strategies• Breaks instead of

timeouts• Define space around

child – armrests, bean bags

• Teach relaxation• Keep It Short and

Simple• Add movement to

learning


Adapt the Environment


Slides Courtesy of Canada FASD curriculum.

Spring 2013

Strategies for Transitions• Timers• Songs• Picture schedules• Establish routines • Child with transition difficulty becomes the

helper• May need to avoid waiting in lines


Eight Simple Keys• Concrete• Consistency• Repetition• Routine• Simplicity (KISS)• Specific• Structure• Supervision

Spring 2013 MN Organization on Fetal Alcohol Syndrome 31

Recognize Strengths!• Friendly, cuddly, happy• Caring, kind and loyal• Curious and involved • Energetic, hard working• Fair and cooperative• Artistic or musical • Highly verbal • Long term visual

memory


Resources

MN FASD Diagnostic Clinics

FASD Clinic; Essentia Health, Children’s Services

Treehouse PsychologyNative American Community Clinic

Lakewood Health System FASD Diagnostic Clinic

White Earth FASD Diagnostic Clinic

Centra care FASD Clinic

Bluestem CenterStillwater Medical Group

MOFAS FASD Diagnostic ClinicCanvas Health FASD & Neurodevelopmental Disorders Diagnostic Clinic

International Adoption Clinic – U of MN

Spring 2013 34MN Organization on Fetal Alcohol Syndrome

Park Nicollet Diagnostic Clinic

U of MN FASD ProgramHealthEast Behavioral Pediatrics Clinic

Online Resources• General Information on FASD

– Center for Disease Control and Prevention, FAS site

• http://www.cdc.gov/ncbddd/fas

– FASD Unit @ the Univ of Washington School of Medicine

• http://depts.washington.edu/fadu/

– MOFAS Resource Directory – • http://www.mofas.org


MN Organization on Fetal Alcohol Syndrome

35Feb 2013

http://www.cdc.gov/ncbddd/fas

http://depts.washington.edu/fadu/

http://www.mofas.org/

Don’t Try Harder Try Differently

If you’ve told a child a thousand times and he still does not understand, then it is not the child who is the slow learner. - Walter Barbee


Contact Information:MOFASPhone: 651-917-2370www.mofas.org

Working with kids with Fetal Alcohol Spectrum Disorders (FASD)

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