National Organization on Fetal Alcohol Syndrome Erin Frey, MD

National Organization on National Organization on Fetal Alcohol Syndrome Fetal Alcohol Syndrome

Erin Frey, MD

NOFAS FASD K-12 NOFAS FASD K-12 PREVENTION PREVENTION CURRICULUMCURRICULUM

LESSON PLANSLESSON PLANS

Fetal Alcohol Fetal Alcohol Spectrum Spectrum

Disorders (FASD)Disorders (FASD)

Fetal Alcohol Fetal Alcohol SyndromeSyndrome

• First described in 1973First described in 1973

• DefinitionDefinition– Fetal Alcohol Syndrome (FAS) is the Fetal Alcohol Syndrome (FAS) is the

term given to a set of physical, mental term given to a set of physical, mental and neurobehavioral birth defects and neurobehavioral birth defects caused by maternal alcohol caused by maternal alcohol consumption during pregnancyconsumption during pregnancy

2005 Surgeon General’s 2005 Surgeon General’s Updated Updated

Recommendations:Recommendations:• Women who are pregnant should not drink.Women who are pregnant should not drink.

• A woman who has already consumed A woman who has already consumed alcohol during pregnancy should stop to alcohol during pregnancy should stop to avoid further risks.avoid further risks.

• Women who are at risk for or are trying to Women who are at risk for or are trying to become pregnant should not consume become pregnant should not consume alcohol. alcohol.

• Health professionals should work with all Health professionals should work with all women of child bearing age to reduce risk.women of child bearing age to reduce risk.

FAS ARND PFAS

Fetal Alcohol Syndrome –only

term diagnosed by health care providers

Alcohol-Related Neurodevelopmental

Disorder

Partial Fetal Alcohol

Syndrome

Fetal Alcohol Fetal Alcohol Syndrome (FAS) Syndrome (FAS)

represents represents only the only the

“tip of the “tip of the iceberg” iceberg” relative to relative to

allallalcohol-related alcohol-related

effects effects

FASD By The NumbersFASD By The Numbers

• 1% of all births (40,000 newborns each 1% of all births (40,000 newborns each year).year).

• Lifetime cost for one individual with FAS is Lifetime cost for one individual with FAS is at least $2 million.at least $2 million.

• Cost to the nation up to $6 billion each Cost to the nation up to $6 billion each year for FAS alone.year for FAS alone.

U.S. Department of Health and Human ServicesU.S. Department of Health and Human Services

Substance Abuse and Mental Health Services AdministrationSubstance Abuse and Mental Health Services Administration

20072007

US Census Bureau

All Alcohol-Related Effects

Alcohol is a TeratogenAlcohol is a Teratogen

• An agent that interrupts or alters the An agent that interrupts or alters the normal development of the fetusnormal development of the fetus

• ““Of all the substances of abuse Of all the substances of abuse (including cocaine, heroin and (including cocaine, heroin and marijuana), alcohol produces by far marijuana), alcohol produces by far the most serious neurobehavioral the most serious neurobehavioral effects in the fetus.”effects in the fetus.”

Institute of Medicine, 1996Institute of Medicine, 1996

Manifestations of CNS Manifestations of CNS Dysfunction Associated Dysfunction Associated

with FASwith FAS

• Attention/memory problemsAttention/memory problems• HyperactivityHyperactivity• Learning disabilitiesLearning disabilities• Behavior ProblemsBehavior Problems• MicrocephalyMicrocephaly• Language & speech problemsLanguage & speech problems• Altered muscle toneAltered muscle tone• Poor fine & gross motor coordinationPoor fine & gross motor coordination• Mental retardationMental retardation

FASD Through the FASD Through the Life SpanLife Span

School Issues and ConcernsSchool Issues and Concerns

Developmental OverviewDevelopmental OverviewEarly School AgeEarly School Age

• Continued sleep problemsContinued sleep problems• Making and keeping friendsMaking and keeping friends• Reading social cuesReading social cues• Boundary issuesBoundary issues• Doesn’t understand Doesn’t understand

stranger safety stranger safety • Easily frustrated/tantrumsEasily frustrated/tantrums• Understanding cause/effect Understanding cause/effect

relationshipsrelationships• Language/SpeechLanguage/Speech• low receptivity/high fluency low receptivity/high fluency • Math problems Math problems

(time/money)(time/money)

Developmental OverviewDevelopmental OverviewSSchool chool AAgege

• Attention and memory Attention and memory problemsproblems

• Learning problems Learning problems (especially arithmetic)(especially arithmetic)

• Uninhibited/impulsiveUninhibited/impulsive• DistractibleDistractible• Lack of organizational Lack of organizational

skillsskills• Developmental delaysDevelopmental delays• Poor coordinationPoor coordination

FAS Developmental FAS Developmental OverviewOverview

AAdolescence and dolescence and AAdultsdults• Anxiety and Anxiety and

depressiondepression

• Lying and StealingLying and Stealing

• Antisocial behaviorAntisocial behavior

• Poor judgmentPoor judgment

• Mood swingsMood swings

• Naïve - victimizationNaïve - victimization

• Socially inappropriate Socially inappropriate behaviorsbehaviors

FAS Adolescents & FAS Adolescents & AdultsAdults

Clinical ImplicationsClinical Implications

• Poor judgment…………………easily victimizedPoor judgment…………………easily victimized

• Attention deficits………….unfocused/distractibleAttention deficits………….unfocused/distractible

• Arithmetic disability……….can’t handle moneyArithmetic disability……….can’t handle money

• Memory problems….......doesn’t learn from Memory problems….......doesn’t learn from experienceexperience

• Difficultly abstracting……..doesn’t understand Difficultly abstracting……..doesn’t understand consequencesconsequences

• Disoriented in time and space….fails to perceive Disoriented in time and space….fails to perceive social cuessocial cues

• Poor frustration tolerance……..quick to angerPoor frustration tolerance……..quick to anger

Potential “Secondary Potential “Secondary Disabilities”Disabilities”

• Early school drop-outEarly school drop-out• Alcohol and drug abuse problemsAlcohol and drug abuse problems• Having children they can’t care forHaving children they can’t care for• JoblessnessJoblessness• Trouble with lawTrouble with law• Mental health problemsMental health problems• Premature deathPremature death

Why Teach About FASDWhy Teach About FASD

• Providing age appropriate education Providing age appropriate education before conception can help reduce the before conception can help reduce the risk of alcohol-exposed births.risk of alcohol-exposed births.

• Schools exercise a powerful influence Schools exercise a powerful influence over young people, making them ideal over young people, making them ideal settings to educate about the dangers settings to educate about the dangers of drinking alcohol during pregnancyof drinking alcohol during pregnancy

• Alcohol remains the number one drug Alcohol remains the number one drug of choice among the Nation’s youthof choice among the Nation’s youth

• Approximately 20% of sexually active Approximately 20% of sexually active teenage girls (15-19) become pregnant teenage girls (15-19) become pregnant each year in the U.S.each year in the U.S.

• In 2004, the rate of past month binge In 2004, the rate of past month binge drinking among pregnant women age 15 drinking among pregnant women age 15 to 17 (8.8%) was more than twice that of to 17 (8.8%) was more than twice that of pregnant women ate 26 to 44 (3.8%).pregnant women ate 26 to 44 (3.8%).

U.S. Department of Health and Human ServicesU.S. Department of Health and Human ServicesSubstance Abuse and Mental Health Services AdministrationSubstance Abuse and Mental Health Services Administration

20072007

K-12 Lesson PlansK-12 Lesson Plans

• What Teachers Need to KnowWhat Teachers Need to Know– Learning about Fetal Alcohol Spectrum Learning about Fetal Alcohol Spectrum

Disorders (FASD)Disorders (FASD)– Signs and Symptoms of FASDSigns and Symptoms of FASD– Common Identifiable Facial Features of Common Identifiable Facial Features of

FASFAS

K-12 Lesson PlansK-12 Lesson Plans

• Sensitivity CautionSensitivity Caution– Discussing alcohol, tobacco, and other Discussing alcohol, tobacco, and other

drugs (ATOD) with studentsdrugs (ATOD) with students

• Family LetterFamily Letter

• 12 Steps to Success For Students With 12 Steps to Success For Students With FASD.FASD.

• Strategies for School StaffStrategies for School Staff

• Websites and ResourcesWebsites and Resources

Skill Emphasis/Health Skill Emphasis/Health Education StandardEducation Standard

• Standard 2 – Students will analyze the Standard 2 – Students will analyze the influence of family, peers, culture, media, influence of family, peers, culture, media, technology and other factors on health technology and other factors on health behaviors.behaviors.

• 2.2.1. Identify how the family influences personal health 2.2.1. Identify how the family influences personal health practices and behaviors practices and behaviors

• Standard 8 – Students will demonstrate the Standard 8 – Students will demonstrate the ability to advocate for personal, family, and ability to advocate for personal, family, and community health.community health.

• 8.2.1. Make requests to promote personal health.8.2.1. Make requests to promote personal health.

• 8.2.2. Encourage peers to make positive health choices.8.2.2. Encourage peers to make positive health choices.

Teaching StepsTeaching Steps

1.1. Read the StoryRead the StoryRead the Read the Karli and the Star of the WeekKarli and the Star of the Week book to students. book to students.

Karli and the Star of the Karli and the Star of the WeekWeek

• A colorfully illustrated story book that A colorfully illustrated story book that teaches youth to be tolerant and teaches youth to be tolerant and accepting of all individuals regardless accepting of all individuals regardless of their capabilities or disabilities. of their capabilities or disabilities.

• 31 Pages31 Pages

2.2. Discussion and Group ActivityDiscussion and Group Activitya.a. Ask students what they think about the Ask students what they think about the

story.story.

b.b. Ask students to recall the disorder, Fetal Ask students to recall the disorder, Fetal Alcohol Syndrome, discussed in story.Alcohol Syndrome, discussed in story.

c.c. Ask students to think of something Ask students to think of something special about themselvesspecial about themselves

d.d. Ask students to think of something Ask students to think of something special about someone else and one of special about someone else and one of their classmatestheir classmates

e.e. Ask students to share something they Ask students to share something they need help withneed help with

3.3. Conclusion – PoemConclusion – Poem

Skill Emphasis/Health Skill Emphasis/Health Education StandardEducation Standard

• Standard 1 – Students will comprehend concepts Standard 1 – Students will comprehend concepts related to health promotion and disease prevention.related to health promotion and disease prevention.

• 1.5.1. – Describe the relationship between healthy behaviors 1.5.1. – Describe the relationship between healthy behaviors and personal health.and personal health.

• 1.5.2. – Identify examples of emotional, intellectual, physical, 1.5.2. – Identify examples of emotional, intellectual, physical, and social health.and social health.

• Standard 5 – Students will demonstrate the ability to Standard 5 – Students will demonstrate the ability to use decision-making skills to enhance health.use decision-making skills to enhance health.

• 5.5.1. – Identify health related situations that might require a 5.5.1. – Identify health related situations that might require a thoughtful decision.thoughtful decision.

• 5.5.3. – List healthy options to health related issues or 5.5.3. – List healthy options to health related issues or problems.problems.

• 5.5.5. – Choose a healthy option when making a decision.5.5.5. – Choose a healthy option when making a decision.

• Standard 7 – Students will demonstrate the ability to Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or practice health-enhancing behaviors and avoid or reduce health risks. reduce health risks. • 7.5.1. – Identify responsible personal health behaviors.7.5.1. – Identify responsible personal health behaviors.• 7.5.2. – Demonstrate a variety of healthy practices and 7.5.2. – Demonstrate a variety of healthy practices and

behaviors to maintain or improve personal health.behaviors to maintain or improve personal health.• 7.5.3. – Demonstrate a variety of behaviors to avoid or 7.5.3. – Demonstrate a variety of behaviors to avoid or

reduce health risks.reduce health risks.

• Standard 8 – Students will demonstrate the ability to Standard 8 – Students will demonstrate the ability to advocate for personal, family and community health.advocate for personal, family and community health.• 8.5.1. – Express opinions and give accurate information 8.5.1. – Express opinions and give accurate information

about health issuesabout health issues• 8.5.2. – Encourage others to make positive health choices.8.5.2. – Encourage others to make positive health choices.

Teaching StepsTeaching Steps

1.1. Nutrition and Health ChoicesNutrition and Health Choices

2.2. Harmful SubstancesHarmful Substances

3.3. Nutrition and Human DevelopmentNutrition and Human Development

4.4. Effects of Alcohol, Tobacco, and Effects of Alcohol, Tobacco, and Other Drugs (ATOD) on the Other Drugs (ATOD) on the Developing FetusDeveloping Fetus

5.5. Discuss Fetal Alcohol Spectrum Discuss Fetal Alcohol Spectrum DisordersDisorders

Activity #1 – CHOICES Activity #1 – CHOICES FOR A HEALTHIER LIFEFOR A HEALTHIER LIFE

Grade 3Grade 3

Activity #2 – Healthier Activity #2 – Healthier Living Word SearchLiving Word Search

Grade 4Grade 4

Activity #3 – Healthier Activity #3 – Healthier Living Living

Crossword PuzzleCrossword Puzzle

Grade 4 or 5Grade 4 or 5

Skill Emphasis/Health Skill Emphasis/Health Education StandardEducation Standard

• Standard 5 – Students will demonstrate the ability Standard 5 – Students will demonstrate the ability to use decision making skills to enhance healthto use decision making skills to enhance health• 5.8.1. – Identify circumstances that can help or hinder 5.8.1. – Identify circumstances that can help or hinder

healthy decision making.healthy decision making.• 5.8.6. – Choose healthy alternatives over unhealthy 5.8.6. – Choose healthy alternatives over unhealthy

alternatives when making a decision.alternatives when making a decision.

• Standard 7 – Students will demonstrate the ability Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or to practice health-enhancing behaviors and avoid or reduce risks.reduce risks.• 7.8.2. – Demonstrate healthy practices and behaviors that 7.8.2. – Demonstrate healthy practices and behaviors that

will maintain or improve the health of self and others.will maintain or improve the health of self and others.• 7.8.3. – Demonstrate behaviors to avoid or reduce health 7.8.3. – Demonstrate behaviors to avoid or reduce health

risks to self and others.risks to self and others.

• Standard 8 – Students will demonstrate the ability Standard 8 – Students will demonstrate the ability to advocate for personal, family, and community to advocate for personal, family, and community health.health.• 8.8.1. – State a health enhancing position on a topic and 8.8.1. – State a health enhancing position on a topic and

support it with accurate information.support it with accurate information.• 8.8.2. – Demonstrate how to influence and support 8.8.2. – Demonstrate how to influence and support

others to make positive health choices.others to make positive health choices.

Teaching StepsTeaching Steps

1.1. Define Fetal Alcohol Spectrum Define Fetal Alcohol Spectrum Disorders (FASD)Disorders (FASD)

2.2. How Common is FASD?How Common is FASD?

3.3. Reinforce A Strong No-Use MessageReinforce A Strong No-Use Message

4.4. Describe How FASD Can Affect the Describe How FASD Can Affect the BrainBrain

5.5. What Are the Symptoms of FASD?What Are the Symptoms of FASD?

Activity #1 – Short-Term Activity #1 – Short-Term Memory ChallengeMemory Challenge

In Class ActivityIn Class Activity

Activity #2 – FASD Activity #2 – FASD Community Advocacy Community Advocacy

ProjectProject

Long-Term AssignmentLong-Term Assignment

Activity #3 – Question Activity #3 – Question and Answerand Answer

In Class ActivityIn Class Activity

Activity #4 – How Much Activity #4 – How Much Do You Know About Do You Know About

Alcohol and Pregnancy?Alcohol and Pregnancy?

In Class or Take Home Activity In Class or Take Home Activity Sheet or QuizSheet or Quiz

Activity #5 – Brain Activity #5 – Brain Structure and Function Structure and Function Identification ExerciseIdentification Exercise

In Class Activity or HomeworkIn Class Activity or Homework

Skill Emphasis/Health Skill Emphasis/Health Education StandardEducation Standard

• Standard 1 – Students will comprehend concepts Standard 1 – Students will comprehend concepts related to health promotion and disease prevention to related to health promotion and disease prevention to enhance healthenhance health• 1.12.1. – Predict how health behaviors can impact health 1.12.1. – Predict how health behaviors can impact health

statusstatus• 1.12.4. – Analyze how genetics and family history can impact 1.12.4. – Analyze how genetics and family history can impact

personal Healthpersonal Health

• Standard 4 – Students will demonstrate the ability to Standard 4 – Students will demonstrate the ability to use interpersonal communication skills to enhance use interpersonal communication skills to enhance health and avoid or reduce health risks.health and avoid or reduce health risks.• 4.12.1. – Utilize skills for communication effectively with 4.12.1. – Utilize skills for communication effectively with

family, peers, and others to enhance health.family, peers, and others to enhance health.• 4.12.2. – Demonstrate refusal, negotiation, and collaboration 4.12.2. – Demonstrate refusal, negotiation, and collaboration

skills to enhance health and avoid or reduce health risks.skills to enhance health and avoid or reduce health risks.

• Standard 5 – Students will demonstrate the ability to use Standard 5 – Students will demonstrate the ability to use decision-making skills to enhance health.decision-making skills to enhance health.• 5.12.1. Examine barriers that can hinder healthy decision 5.12.1. Examine barriers that can hinder healthy decision

making.making.• 5.12.2. – Determine the value of applying a thoughtful decision 5.12.2. – Determine the value of applying a thoughtful decision

making process in health related situations.making process in health related situations.• 5.12.7. – Evaluate the effectiveness of health-related decisions.5.12.7. – Evaluate the effectiveness of health-related decisions.

• Standard 7 – Students will demonstrate the ability to Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce practice health-enhancing behaviors and avoid or reduce risks.risks.• 7.12.1. – Analyze the role of individual responsibility for 7.12.1. – Analyze the role of individual responsibility for

enhancing healthenhancing health• 7.12.3. – Demonstrate a variety of behaviors to avoid or reduce 7.12.3. – Demonstrate a variety of behaviors to avoid or reduce

health risks to self and others.health risks to self and others.• Standard 8 – Students will demonstrate the ability to Standard 8 – Students will demonstrate the ability to

advocate for personal, family and community health.advocate for personal, family and community health.• 8.12.2. – Demonstrate how to influence and support others to 8.12.2. – Demonstrate how to influence and support others to

make positive health choices.make positive health choices.• 8.12.3. – Work cooperatively as an advocate for improving 8.12.3. – Work cooperatively as an advocate for improving

personal, family and community health.personal, family and community health.

Teaching StepsTeaching Steps

1.1. Define Fetal Alcohol Spectrum Define Fetal Alcohol Spectrum Disorders (FASD)Disorders (FASD)

2.2. How Common Is FASD?How Common Is FASD?3.3. Reinforce A Strong No-Use MessageReinforce A Strong No-Use Message4.4. What Is Considered A Drink?What Is Considered A Drink?5.5. What Role Do Partners, Friends and What Role Do Partners, Friends and

Family Members Play?Family Members Play?6.6. View the View the Law & Order: SVULaw & Order: SVU Video Video

Activity #1 – Discuss Activity #1 – Discuss the Videothe Video

Classroom ActivityClassroom Activity

Activity #2 – Alternative Activity #2 – Alternative Ending To Ending To Law & Order: Law & Order:

SVUSVU Video Video

Homework AssignmentHomework Assignment

Activity #3 – Alcohol Activity #3 – Alcohol and Pregnancy Decision and Pregnancy Decision

MakingMaking

Case StudiesCase Studies

Activity #4 – How Much Do Activity #4 – How Much Do You Know About Alcohol You Know About Alcohol

and Pregnancyand Pregnancy

Activity Sheet/QuizActivity Sheet/Quiz

Alcohol-Related Alcohol-Related Birth Defects Birth Defects

100% are 100% are preventablepreventable

You can help educate a You can help educate a new generation and new generation and keep them free from keep them free from

alcohol exposed alcohol exposed pregnancies.pregnancies.

Erin Frey, MDProgram Director

National Organization on Fetal Alcohol Syndrome900 17th Street NW, Suite 910

Washington, D.C. 20006Phone: 202.785.4585 ext. 203

Fax: 202.466.6456frey@nofas.orgwww.nofas.org