what is FASD?
FASD is a diagnostic term used to describe a broader spectrum of presentations and disabilities resulting from alcohol exposure in utero.
challenging in diagnosing
- No specific and uniformly accepted diagnostic criteria have been available for facial malformations, growth retardation, CNS abnormalities, confirmation of maternal alcohol consumption
- Not all children or older adults with FASD look or act the same
- Lack of knowledge and misconceptions among primary care providers, i.e: FASD can only occur if the mother is alcoholic, FASD only occurs among low-income families or other racial and ethnic minority groups
- Lack of diagnostic details to distinguish FASD from other similar diseases, i.e: Williams syndrome
diagnosis framework
- Initial recognition of a child or older individual has a potential FASD. The recognition of developmental problems, facial abnormalities, growth delay can come from the notice of parents, daycare staff, school system
- The referral process is initiated at the point a clinician starts to have suspicions of an alcohol-related disorder for a child, the evaluation gathers specific data to diagnostic criteria
- FASD diagnosis uses dysmorphic and anthropometric assessment with neurodevelopmental evaluation data. Intervention Plan is developed using a multidisciplinary team approach: physician, child-develop specialist, psychologist, speech-language pathologist
criteria
- All three facial features: smooth philtrum, thin vermillion border, small palpebral fissure
- Growth deficit: confirmed prenatal or postnatal height or weight, or both, at or below 10%, adjusted for age, sex, race or ethnicity
- Central nervous system problem, i.e intellectual deficits, cognitive or developmental deficits, executive functioning deficits, motor functioning delays, problem with attention or hyperactive, pragmatic language problems, memory deficits
● Maternal alcohol exposure: confirmed or unknown
incidence and causes
Caused by drinking during pregnancy
● 1 in every 9 pregnant women between the ages of 18-44 years old drinks during pregnancy
● ⅓ of those women admitted to binge drinking
No Exact number of how many kids get affected by FASD
● Only about 10% of newly born baby’s affected with alcohol, exhibit symptoms and abnormalities
US population
● Based on the medical records by CDC, studies have shown that 0.2 - 1.5 out of 1000 babies born has FASD
● Most recent study states that there are only .3 out of 1000 babies have FASD from ages 7-9
In person Studied Identified
● studies in person identified that 6-9 babies out of 1000 will have FASD
● 1-5 per 100 children in school suffers from FASD
Canada population
● In Canadian population about 1 out of 1000 babies would be diagnosed to have FASD
● Its estimated that 3,000 canadian babies a year will have FASD
● According to the Government of Canada about 300,000 people in canada is living with FASD
● FASD is a lot more significant in the indigenous population
In Manitoba
● The prevalence of having FASD in Manitoba is about 113 out of 1000 which is 13% higher that estimated in a general population
difficulties
● It has been observed that as high as 85% of the people with FASD have sleeping problems
● hearing loss occurs for about 83% of people with FASD
● 67% of FASD children have deficits in attention or is hyper active (ADHD)
● Some people even suffer from difficulty with facial recognition
treatment
There is no cure for FASD however…
● Early Intervention Services
● Services that help babies and toddlers with developmental delays or disabilities
● Birth to 3 years old - learn essential skills
○ Physical, cognitive, communication, social/emotional, self help
■ Services such as Speech and language, Physical and
Occupational, Psychological
○ Improves self esteem, self awareness, daily functioning, learning to cope with new situations
protective factors
Key to minimize secondary disabilities associated with FASD: ● Early Diagnosis ● Involvement in special education and social services ● Stable home environment ● Absence of violence Types of Treatments: ● Medical Care/Medication ● Behavior and Education Therapy ● Parent Training ● Alternative Approaches
importance of protective factors
An early diagnosis, and an effective management plan for on-going supports can help
prevent people with FASD from developing secondary disabilities, such as:
● Mental health problems (like depression or obsessive-compulsive disorder);
● Dropping out of, or disrupting, school
● Trouble with the law
● Chronic unemployment
● Alcohol and drug problems; and
● Homelessness.
medical care/medication
Same needs as people without FASD
● Vaccinations, good nutrition, exercise, hygiene
Specific concerns that are associated with FASD must be monitored by specialist
● Pediatricians, plastic surgeons, occupation/physical therapist
No specific medication to treat FASD, but can help manage symptoms *Affect every child differently, one might work well and one might not
● Stimulants – hyperactivity, attention spans, poor impulse control
● Antidepressants – sad mood, school disruption, antisocial behaviours
● Neuroleptics – aggression, anxiety
● Anti-anxiety – symptoms of anxiety
behavior and education therapy
Good Buddies
● Friendship Training to teach social skills
● Group format; held in 12 sessions
● Child host play date with classmate or peer
Math Interactive Learning Experience
● Deficits in mathematical functioning have been reported consistently among alcohol-affected individuals.
● Improve child’s mathematical knowledge and skill
● One to one tutoring using specifically adapted materials
parent training
Children with FASD may not respond to standard parenting practices
● Training can be done in groups or individual families
TIPS
● Concentrating on child’s strengths/talents
● Accepting child’s limitations
● Using specific language; keeping it simple
● Learning with visual aids, music and hands on activities
● Positive reinforcement (praise, incentives)
alternative appraoches
- yoga and exercise
- animal assisted therapy
ranges of severity
- Fetal alcohol syndrome ( FAS)
- Partial fetal alcohol syndrome ( pFAS)
- Alcohol related neurodevelopmental disorder (ARND)
- Alcohol related birth defects ( ARBD)
Fetal alcohol syndrome
● Fetal death = most extreme outcome from drinking during pregnancy
● Might have abnormal facial features, growth/central nervous system problems
● Trouble with learning, memory, communication, vision or hearing
● Criteria:
○ Growth deficit: below normal
○ FAS Facial Features: must have all three
■ Smooth philtrum, thin upper lip, wide appearance of eyes
○ CNS damage
○ Confirmed/unconfirmed prenatal alcohol exposure
FAS Facial Feature Ranking:
● Developed by University of Washington
● 5 point Likert Scale with photos
● Normal = 1 Severe = 5
● Ranking facial features is quite complicated
Partial fetal alcohol syndrome
● Person does not meet full diagnostic for FAS
criteria
● Most, but not all, of the growth deficits and/or
facial features of FAS
● Damage to CNS
● Confirmed prenatal alcohol exposure
● Criteria:
○ Growth Deficit: may range from normal to
deficient
○ FAS facial features: two or three present
○ CNS damage
○ Confirmed Prenatal alcohol exposure
alcohol related neurodevelopmental disorder
● Diagnostic categorization for individuals who have: ○ Damage to CNS ○ Confirmed prenatal alcohol exposure ● Intellectual disabilities ● Problems with behaviour and learning ● Might do poorly in school ● Struggle with: ● Math, memory, attention, judgement, and poor impulse control
alcohol related birth defects
● Have problems with: ○ Hearing ○ Heart ○ Kidneys ○ Bones ● These features are not criteria for diagnosing FASD ● The Canadian Guidelines suggest ARBD should not be used as an umbrella term or diagnostic category for FASD
symptoms
● Inconsistent memory and recall
● Inability to filter out environmental or emotional distractions and sensory stimuli
● Slow and inconsistent cognitive and auditory processing
● Decreased mental stamina
● Difficulty interpreting and applying abstract concepts (for example, managing
money and time)
● Impulsivity and poor judgment
● Inability to predict outcomes (of their own or others’ actions)
● Difficulty shifting from one context to another
● Resistant to change
● Inability to see another person’s perspective
● Inability to recognize indirect social cues
teaching and coaching
- Ensure educational environment is modified to the student’s unique needs
- 5 essential teaching methods
1. A structured environment
2. Consistent Routine
3. Brief Presentation
4. Variety
5. Repetition
a structured environment
- Teach a few simple rules
- Concrete rules
- Write them down
- Enforce rules in a consistent manner
- Simplify student notebooks and belongings
- Use one notebook for each subject
- Color code dividers for each subjects
- Keep communication open b/w home and school
- Include a daily homework sheet in the student’s notebook that requires a parent/guardian signature
a consistent rule
- Assign seats
- Keep these constant throughout the year
- Post and review the daily schedule
- Keep schedule predictable and consistent
- Activities should occur the same time each day
- Linear clock
- Review the schedule at the end of the day
- Prepare students ahead of time for transitions/changes
from the schedule - Recognize the following types of transitions or changes in routine can cause difficulty
- New student, sub. Teacher, new
classroom, switching subjects, new skill - Provide signals to let students know transition is coming
- Ring a bell
- Turn the light switch on and off
