Embed Size (px)
Citation preview
FETAL ALCOHOL SPECTRUM DISORDERS
(FASD)3rd Annual Addictions & Mental Health
ConferenceToronto, ON May 24 to 26, 2015
Prepared by:
ALICE M. BELLAVANCE, RPN
Chief Executive Officer, BISNO
Based on research from
the:
U.S. Department of
Health & Human Services
Substance Abuse and
Mental Health Services
Administration (SAMHSA)
Fetal Alcohol Spectrum Disorders
(FASD) Centre for Excellence
1
BEAUTIFUL CHILDREN
2
DEFINITIONS WITHIN THE FETAL ALCOHOL SPECTRUM DISORDERS
FAS = Fetal Alcohol Syndrome
ARND = Alcohol Related Neurodevelopmental Disorder
ARBD = Alcohol Related Birth Defects
FASD = Fetal Alcohol Spectrum Disorders
3
FETAL ALCOHOL SPECTRUM DISORDERS (FASD)
Behaviour often appears intentional or purposeful
Typical approaches to “difficult/responsive” behaviours are often unsuccessful
Many individuals living with FASD have other challenges
Not all behaviour can be categorically be said to be due to FASD
Pre-natal alcohol exposure causes brain damage resulting in FASD
As such we can begin to understand why individuals with FASD experience limitations
4
BRAIN STRUCTURES AFFECTED BY PRENATAL ALCOHOL EXPOSURE
BASAL GANGLIA especially the caudate nucleus:
Cognition Emotion Motor activity CORPUS CALLOSUM: Connects 2 halves of the
brain facilitates communication
between the 2 halves 5
BRAIN STRUCTURES AFFECTED BY PRENATAL ALCOHOL EXPOSURE
FRONTAL LOBES: Controls emotional responses & processing
of humour Controls expressive language Assigns meanings to words Processing of information Determining how to act in a specific
situation
If the brain were so simple to understand, we’d be too
simple to understand it6
BRAIN STRUCTURES AFFECTED BY PRENATAL ALCOHOL EXPOSURE
HIPPOCAMPUS:
Memory Learning Emotion Aggression AMYGDALA: Fear Anger Aggression
7
SUMMARY OF MRI FINDINGSADAPTED FROM: RILEY (2006) Brain imaging studies indicate size
reduction in the cerebral vault, cerebellum, basal ganglia, corpus callosum, as well as overall brain size
Greater amounts of gray matter and lesser amounts of white matter in some areas and less symmetry
These brain changes can be related to changes in behaviour, cognitive functions and some physical activities
Interference with the development of myelin has also been found die to prenatal alcohol exposure 8
MRI, MRS & FMRI STUDY FINDINGS SUSAN ASTLEY (2009)
Study conducted at the University of Washington
Frontal lobes were found to be disproportionately smaller in those with the facial features of FAS
MRI’s previously done were mostly read as normal
Even those with mild ARND had structural brain damage by scan* We need to determine whether these structural differences have functional consequences with population based norms
9
MRI, MRS & FMRI STUDY FINDINGS SUSAN ASTLEY (2009)
Those with prenatal alcohol effects scored similarly to controls on a one-back test (does this picture match the last one you saw?)
Those with prenatal alcohol effects scored significantly poorer on the two-back test (does the picture match the one you saw two back?)* The level of activation in the Dorsolateral Prefrontal Cortex is significantly less in those with FASD* This is a measure of working memory
10
RECENT ANIMAL STUDIES ON ANXIETY – JOANNE WEINBERG (2008)
Studies examine how prenatal alcohol exposure and other early nutritional or environmental insults affect neurobiological systems in an animal model and implications for intervention
* Altered hormonal, immune and behavioural function
* Special focus on stress
11
RECENT ANIMAL STUDIES ON ANXIETY – JOANNE WEINBERG (2008)
INITIAL FINDINGS INCLUDE: Maternal alcohol consumption increases HPA
(hypothalamic-pituitary-adrenalin) activity & alters HPA regulation in the mother & offspring
HPA is the stress axis This HPA hyperactivity is observed under
baseline conditions & following exposure to stress
HPA may be the common pathway for early adverse life experiences
Interventions targeted to normalizing the HPA axis may provide a novel approach to interventions
12
POSSIBLE PROTECTIVE FACTORS Animal research on choline as a possible
protective factor In pregnant mice who have been given
ethanol, choline appears to mitigate the effects of the ethanol
Effects of ethanol on the fetus seem to lessen even if administered after the ethanol exposure
Choline administration has a positive effect on the cognitive abilities when given to mouse pups
Effects, amounts & form of choline in humans is not known
Human studies are beginning13
POSSIBLE PROTECTIVE FACTORS This does not mean that a woman can
drink & take choline & have a healthy baby
This does mean that the use of choline during pregnancy should be discussed with the woman’s physician
* Good prenatal care is important* As long as stigma remains, women
who are drinking during pregnancy are less likely to seek prenatal care
Studies using Aricept are underway with Joanne Weinberg
14
WHY DIAGNOSE? It helps us to be proactive in identifying
difficulties & developing interventions It can reduce anger & frustration It can lead to better prevention It helps to prove how common it is
* Hopefully leading to funding to address prevention & treatment
It can improve outcomes for agencies & systems
* Reducing recidivism by providing supports required for success
15
BENEFITS TO THE INDIVIDUAL OF GETTING A DIAGNOSIS KNIGHT & DUBOVSKY (2007)
Recognition that there is a reason they have some of the difficulties that they do
* More amenable to support regarding health & social service issues
The realization that they are not just “stupid”, “bad” or “crazy”
* The feeling of being “bad” over time leads to behaviour that reinforces the
image * The feeling of being “stupid” often leads to truancy or acting out in
school16
BENEFITS TO THE INDIVIDUAL OF GETTING A DIAGNOSIS KNIGHT & DUBOVSKY (2007)
The ability to anticipate things with which they might have difficulty & be proactive in developing techniques to be successful
* E.g. recognizing difficulties with multiple directions & asking for directions or
instructions to be repeated* Difficulty remembering what needs to be done & developing lists, posting them where they will be seen & developing a routine to review them regularly
Less resistant to structure & protective supervision
17
BARRIERS TO OVERCOME FOLLOWING A DIAGNOSIS FOR THE INDIVIDUAL
KNIGHT & DUBOVSKY (2007)
Seeing oneself as not able to do anything, thus giving up
Dealing with others’ view that they are not competent
Thinking that everything he or she experiences is because of FASD
* Not recognizing the need to get help for other problems e.g. depression, trauma, domestic violence, other mental health issues
Realization that FASD is a life long challenge Negative self-image is shaken & need to
redefine perception of self18
BENEFITS TO FAMILY OF GETTING DIAGNOSIS FOR A FAMILY MEMBER
KNIGHT & DUBOVSKY (2007)
Potential for financial support i.e. tax benefit, disability pension
Recognition that its a brain based disorder Reduction of frustration & anger towards
their loved one Reduction of self-blame Opportunity to heal from years of
confusion & trauma Ability to not take behaviour personally Ability to identify & build on strengths Ability to “kvell”
19
BARRIERS FOR THE FAMILY TO OVERCOME FOLLOWING THE DIAGNOSIS
KNIGHT & DUBOVSKY (2007)
Feelings of hopelessness Linking all the difficulties to FASD
* Overlooking other reasons for difficulties e.g. co-occurring mental health & other disorders
* Not considering possible medical reasons for behaviours or other difficulties
Concern about “labeling” their loved one Sense of guilt, failure, shame, stigma, anger Realization that there are life long issues
requiring lifelong support Need to confront issues of loss & grieving
20
BENEFITS TO SERVICE PROVIDERS FOLLOWING A DIAGNOSIS
KNIGHT & DUBOVSKY (2007)
Ability to develop successful interventions in prevention & treatment
Ability to view the individual as having a disability rather than being “noncompliant”
* Move beyond anger & frustration Ability to improve outcomes Increased opportunity for service providers
to feel successful Development of increased services based
on recognition of the extent of FASD Increased ability to make a difference
21
BARRIERS FOR SERVICE PROVIDERS FOLLOWING A DIAGNOSIS
KNIGHT & DUBOVSKY (2007)
Need to adapt services to the needs of the individuals & their families
Need to implement truly individualized approaches – feeling that it is more appropriate (or easier) to treat everyone the same
Lack of needed services Inability to secure funding for required
services View that all behaviour is due to FASD –
missing possible misdiagnosis or co-occurring issues that need to be addressed
22
BARRIERS FOR GOVERNMENT & OTHER FUNDERS TO OVERCOME
RE: DIAGNOSIS KNIGHT & DUBOVSKY (2007)
Need to find funding for services Dealing with competing priorities e.g. brain
injury, autism Need to raise the issue of alcohol use
(some funders & politicians may well have FASD in their families)
Distorted view that alcohol use by women who are pregnant is a conscious decision
*Therefore, women should be punished
23
CONSEQUENCES OF NOT RECOGNIZING AN FASD IN AN
INDIVIDUAL Individuals living with FASD often fail with typical
education, parenting, treatment, justice, vocational, housing & benefit programs
* They often look “normal”* They tend to be very verbal* They say they know what they need to & don’t follow through* We take what they say at face value
We utilize typical approaches, such as the notion that the way people learn is to experience the consequences of their behaviour – if we utilize that concept, we often place the individual at risk of ending up homeless, in jail or dead
24
CONSEQUENCES OF NOT RECOGNIZING AN FASD IN AN
INDIVIDUAL Repeatedly in treatment settings having “failed”
treatment* Multiple admissions for substance abuse treatment* Multiple admissions for mental health treatment
Difficulty in school, especially middle & high school
Repeated difficulty maintaining employment Repeated trouble with the law – especially for
committing the same crime more then once and/or repeatedly breaching probation/parole
Frequently homeless 25
CONSEQUENCES OF NOT RECOGNIZING AN FASD IN A CAREGIVER
Caregivers with unrecognized FASD are often labeled as neglectful, uncaring or sabotaging
We provide multiple verbal instructions Especially in child welfare:
* We place their children* We tell the parents what they need to do
to get their children back – completion of multiple tasks is expected
* They say they know what they need to do but they don’t follow through on instructions e.g. appointments, visits, phone calls, treatment, housing, employment, income
We threaten termination of parental rights26
CONSEQUENCES OF NOT RECOGNIZING AN FASD IN A CAREGIVER
They fail benefit programs that are time limited & based on the concept of willful behaviour & motivation as the key to success
They fail in typical treatment & parenting programs
Women may have another child with FASD Remember that an FASD is always a diagnosis for
a family* If a child is identified with an FASD, we
must examine the siblings, parents & other kin
* We must view the whole family as the focus of attention, assessment and support
27
WHAT TO EXPECT FROM A PERSON WITH AN FASD
Friendly Talkative Strong desire to be liked Desire to be helpful Naïve & gullible Difficulty identifying dangerous people or
situations Difficulty following multiple directions or rules –
may be able to recite the rules but not know how to follow them
Interrupt group activities; act inappropriately; don’t follow the course of group discussions
Literal/concrete thinker 28
DIFFICULTIES IN LITERAL/CONCRETE THINKING
Do “exactly” as told Difficulty with recognizing the
consequences of actions (cause & effect) Difficulty with the concept of time Difficulty with a sense of space Difficulty in level, point or reward systems Difficulty managing money Difficulty with sarcasm, joking, similes,
metaphors, proverbs, idiomatic expressions
29
SAYINGS THAT MAY BE MISINTERPRETED
Clean your room Take a shower Go take a hike You’re shooting yourself in the foot Go to your room & think about what you
did wrong Don’t run across the street Don’t drink & drive Wait your turn Follow the rules Do what I told you to do Call with any questions
30
WHAT TO EXPECT FROM A PERSON WITH FASD
Modeling the behaviour of those around them
Inconsistent in abilities Don’t hold a grudge Do better one on one Repeat mistakes Frustrating but likeable Difficulty correctly reading social cues Risk of repeated homelessness Risk of repeated interactions with the
criminal justice system31
FASD AND SEXUALLY TRANSMITTED INFECTIONS People with FASD are at risk for HIV & sexually
transmitted infections Difficulty avoiding dangerous situations Difficulty negotiating safe sex Difficulty remembering to use safe sex
techniques For people with an FASD, the approach to
prevention of HIV & sexually transmitted infections must be different
* Literal* Repeated* Role playing of situations the person
might find him or herself in32
FASD & SEXUALLY TRANSMITTED INFECTIONS For people with a co-occurring FASD & HIV, or
sexually transmitted infection, treatment approaches need to be different
Treatment needs to be broken down to one step at a time
Medication schedules need to be simplified Direct one on one support needs to be
provided to attend appointments & follow treatment regimen
Discussions about the importance of treatment & issues regarding re-infection need to be repeated – always check for true understanding
33
WHY WE NEED TO CONSIDER AN FASD AS A CO-OCCURRING DISORDER
If an FASD is not recognized, a misdiagnosis may be made
Treatment may not be effective If FASD is not recognized as a co-
occurring disorder, typical treatments for the disorder are used
* Treatment may not be effective due to information processing issues in FASD
34
PROFILE OF 80 BIRTH MOTHERS OF CHILDREN WITH FAS (ASTLEY 2000)
96% had 1 to 10 mental health disorders
* 59% major depressive episode* 22% manic episode/bipolar
disorder* 7% schizophrenia* 77% PTSD
95% had been physically or sexually abused during their lifetime
79% reported having a birth parent with an alcohol problem
35
PROFILE OF THE OTHER 80 BIRTH MOTHERS OF CHILDREN WITH FAS
(ASTLEY 2000)
40 were deceased –homicide - suicide -accidental death
40 were unable to participate due to circumstances
36
LIKELY CO-OCCURRING DSM DISORDERS WITH FASD
ADHD Schizophrenia Major depression Bipolar disorder Addiction Anxiety Disorder PTSD TBI/ABI
Sensory Integration Disorder
Reactive attachment disorder
Organic Tic disorder OCD ODD/Conduct
disorder Medical disorders
e.g. seizures, heart abnormalities
37
POSSIBLE MISDIAGNOSIS FOR INDIVIDUALS WITH FASD
ADHD ODD/Conduct
disorder
38
FASD ADHD ODD
BEHAVIOUR DOES NOT COMPLETE TASKS
Underlying cause for the behaviour
•May or may not take in the information•Cannot recall the information when needed•Cannot remember what to do
•Takes in the information•Can recall the information when needed•Gets distracted
•Takes in the information•Can recall the information when needed•Chooses not to do what they are told
Intervention for the behaviour
•Provide one direction at a time
•Limit stimuli and provide cues
•Provide positive sense of control, limits and consequences
COMPARING FASD, ADHD &ODD(D. DUBOVSKY 2002)
39
COMPARING FASD, ADHD & CONDUCT DISORDER (D. DUBOVSKY 2002)
FASD ADHD CONDUCT DISORDER
BEHAVIOUR TAKES RISKS
Underlying cause for the behaviour
•Does not perceive danger
•Acts impulsively
•Pushes the envelope; feels omnipotent
Intervention for the behaviour
•Provide mentoring; use repeated role playing
•Use behavioural approaches (e.g. stop & count to 10)
•Use psychotherapy to address issues; protect from harm
40
COMPARING FASD, ADOLESCENT DEPRESSION & ADOLESCENT
BIPOLAR DISORDER (D. DUBOVSKY 2002)
FASD Adolescent Depression
Adolescent Bipolar Disorder
•Acting out antisocial behaviour
•Acting out antisocial behaviour
•Acting out antisocial behaviour
•Misreading social cues; modeling others; difficulty communicating thoughts & feelings
•Depression •Mania or hypomania
•Provide a mentor to model positive behaviours; utilize a lot of role playing
•Psychotherapy to address issues; protect from harm; medicate (antidepressants) with careful monitoring
•Psychotherapy to address issues; protect from harm; medicate (mood stabilizer)
41
POSSIBLE MISDIAGNOSIS FOR INDIVIDUALS WITH AN FASD
Adolescent depression Bipolar disorder Intermittent Explosive Disorder Autism Asperger’s Syndrome Reactive Attachment Disorder Traumatic Brain Injury Antisocial Personality Disorder Borderline Personality Disorder
42
LANGUAGE ISSUES IN FASD
Early language development may be delayed Often verbal output without a lot of content Verbal receptive language is more impaired
the verbal expressive language* A person with an FASD may be able to talk a good game but not be able to
process or use all of what they hear* They will often do what they think
they need to based on the pieces they have processed – this will frequently look like purposeful oppositional or
uncooperative behaviour Verbal receptive language is the basis of
most of our interactions with people43
SITUATIONS THAT RELY ON VERBAL RECEPTIVE LANGUAGE PROCESSING
Parenting techniques Elementary & secondary education Child welfare Judicial system Treatment
* Motivational interviewing* Cognitive behavioural therapy* Group therapy* AA/NA Groups
Awareness campaigns
44
SITUATIONS THAT RELY ON VERBAL RECEPTIVE LANGUAGE PROCESSING
Court proceedings
Requirements in jail, correction &/or detention centres
Correspondence related to any of the above
45
WHY A PERSON WITH AN FASD MIGHT BECOME HOMELESS
Difficulty with social language Naïve & gullible Easy marks for negative manipulation &
abuse Lack of supports
* Often have few or no supports; may not be “in the system”
* Majority of their supports are professionals or family
* Loss of support of parents as they get older & their parents are no longer able to provide support or they’ve died
46
DIFFICULTIES IN TREATMENT FOR INDIVIDUALS WITH AN FASD
Sporadic in keeping appointments Difficulty doing things on their own Consistently get into difficulty with others Viewed as manipulative, unmotivated & non-
compliant Problems in programs rely on:
* Verbal receptive language skills* Processing information outside of sessions* Making life decisions on one’s own* Following through on one’s own* Asking for help when they need it (lacking insight into their limitations)
47
DIFFICULTIES IN TREATMENT FOR INDIVIDUALS WITH AN FASD
Wander away, “fade out’, “space out” and/or talk inappropriately in group situations
Need tremendous amount of one-to-one support
Most treatment programs do not allow external supports due to confidentiality requirements for other individuals in treatment
Seem to have the same issues from week to week
They “just don’t get it”48
A STRENGTH BASED APPROACH TO IMPROVING OUTCOMES
Identify strength & desires in the individual* What do they do well?* What do they like to do?* What are their best qualities?* What are your funniest experiences with them?
Identify strengths in the family Identify strengths in the providers Identify strengths in the community –
include cultural strengths when appropriate
49
STRENGTHS OF PERSONS WITH AN FASD Friendly Likeable Verbal Helpful Caring Hard
worker Determine
d
Have points of insight
Good with younger children*
Not malicious
Every day is a new day
*D. Dubovsky: Drexel University College of Medicine 1999 50
STRATEGIES FOR IMPROVING OUTCOMES FOR INDIVIDUALS
WITH AN FASD Simplify the individual’s environment
* Simplify routines* Simplify the person’s room* Be consistent in activities & times
Provide one direction or rule at a time* Review directions & rules regularly* Check for true understanding* Talk about how to help the person follow the direction or rule
Use a lot of repetition
51
STRATEGIES FOR IMPROVING OUTCOMES FOR INDIVIDUALS
WITH AN FASD
Use repeated role playing, preferably with videotaping
Identify strengths in the individual, family & providers
Provide a lot of one-to-one physical presence
Softer lighting, softer colours, softer sounds
Use short term consequences Do not use natural consequences;
especially if they put the person at risk52
STRATEGIES FOR IMPROVING OUTCOMES FOR INDIVIDUALS
WITH AN FASD Be aware of and discuss,
misinterpretations of words or actions of others when they occur
Find something that the person likes to do & does well (that is safe & legal) and arrange to have the person do that regardless of behaviour
Create “chill out” spaces in each setting Use literal language Use first person language
53
USE LITERAL LANGUAGE Do not use metaphors or similes Do not use idiomatic expressions & proverbs
* A little bird told me* A day late & a dollar short* People in glass houses shouldn’t throw stones* He’s a sitting duck* I’m all ears
Be careful about joking with the person Think about how what you might say could
be misinterpreted
54
PERSON FIRST LANGUAGE He’s a child with FASD not “he’s an FASD
kid” A person affected by prenatal alcohol
exposure, not “the affected person” A mother with FASD, “not an FASD mom” She has intellectual challenges, not
“she’s mentally retarded” He has a mental illness, not “he’s
mentally ill” He has schizophrenia, not “he’s
schizophrenic” No one is “FASD” although a person may
be living with the effects of FASD55
STRATEGIES FOR IMPROVING OUTCOMES FOR INDIVIDUALS
WITH AN FASD Set the person up to succeed
* Be creative* Use mentoring programs:
* The person with an FASD having a mentor* The person with an FASD being a mentor* Interview, train and supervise mentors
* May need to change the definition of success View FASD as a life long disorder
* Services cannot be short term* It doesn’t mean that people will need intensive services for their lifetime
56
STRATEGIES IN DRUG & ALCOHOL TREATMENT PROGRAMS
Ask about prenatal alcohol use in all assessments
Limit the number of meetings per week Go to the same meetings on the same days
each week Have someone be responsible for taking
the person to each meeting for a least 6 months* Discuss each meeting with the person
Utilize open meetings if necessary Don’t view inability to follow through as a
lack of motivation57
STRATEGIES IN SOCIAL SITUATIONS
Discuss desires for social interactions Be aware of & discuss, misinterpretations of
words or actions of others when they occur Provide a socialization coach
* To form a positive relationship* To model social interactions for the individual in vivo* To do activities with the person* To discuss interactions* To provide immediate feedback & alternatives
58
STRATEGIES FOR SUCCESSFUL EMPLOYMENT
Indentify the interests of the individual Provide a job coach Help the individual learn one step of the
job at a time Keep the job coach with the individual
for at least 6 months* To address the social aspects of the job* To deal with problems as they occur, not days later
59
STRATEGIES FOR SUCCESSFUL EMPLOYMENT Educate management on the job as to
the needs of the individual & best ways to approach the person
Identify a person to whom the individual can go when there is an issue/problem
Provide positive feedback Follow-up regularly; do not wait for the
person to come to you
60
STRATEGIES FOR SUCCESSFUL HOUSING
Anticipate possible difficulties for a person with an FASD
Arrange for a way to ensure that the person’s rent is paid monthly if that’s a problem
Limit the number of rules Break down expectations to one at a time
where possible Provide the person with a mentor Arrange for someone to work with the
individual to clean their room or apartment, do laundry, etc.* “Once & done” should not be an option
61
RECOGNITION OF A CO-OCCURRING FASD INFORMS INTERVENTIONS
Do not rely on verbal processes Be careful about the words that are used
* Be literal, not abstract Do not expect the individual to think about
things on their own & make decisions about their life
Break things down to one step or rule at a time
Utilize supportive psychotherapy rather than cognitive behavioural therapy approaches
Recognize suicide risk62
ISSUES REGARDING DEVELOPMENT TO CONSIDER In addition to recognizing possible co-
occurring disorders & misdiagnosis & the secondary disabilities of having FASD, it is essential to keep in mind that individuals with an FASD go through typical developmental stages, although possibly at different times
Some behaviours may be expressions of normal development
It may be helpful to ask yourself “what age of development does this behaviour feel, like”
63
WHY DO PEOPLE WITH AN FASD “FAIL”
Disruptions in development affect their actions* If they look “normal” & are intelligent, we often dismiss this possibility
Difficulties in early affect regulation can impact later behaviours
It is essential to consider development & affect regulation in planning interventions for individuals with an FASD
64
RECOGNITION OF A CO-OCCURRING FASD INFORMS INTERVENTION
Do not take lack of follow through as lack of motivation
Identify possible buddies (e.g. family, friends, church, or other organizations) to ensure the person gets to their appointments, etc.
Establish a mentor/coach approach Change rewards based systems (e.g.
point, level or sticker systems) Re-assess concepts of dependency &
enabling
65
RECOGNITION OF A CO-OCCURRING FASD INFORMS INTERVENTION
Women with an FASD are at high risk of giving birth to a child with FASD* Successful treatment for these women (needing to recognize their FASD) is an essential prevention technique* Successful treatment for women at risk is cost effective
Utilize a strengths based approach Modify typical approaches to take into
account the co-occurring FASD
66
APPROACHES THAT NEED TO BE MODIFIED FOR THOSE WITH A
CO-OCCURRING FASD
Individual therapy Group therapy Point, sticker, star & level systems Motivational interviewing Cognitive Behavioural Therapy
(CBT) Screening for alcohol use
67
APPROACHES THAT NEED TO BE MODIFIED FOR THOSE
WITH A CO-OCCURRING FASD
Parenting Education Prevention efforts 12 step programs Any approach that relies on verbal
receptive language processing Zero tolerance policies
68
IMPORTANCE OF PREVENTING FASD: FACTS TO CONSIDER
FASD is one of the few birth defects that is 100% preventable
There is no known safe amount of alcohol to use during pregnancy
There is known safe time to drink during pregnancy
Most women do not know when they become pregnant
The only proven safe amount of alcohol to drink during pregnancy is NONE
Fetal alcohol spectrum disorders can occur in any community where women drink
69
RECOGNIZING A POSSIBLE FASD IN AN INDIVIDUAL
A person may have FASD if he or she:* Does not respond the way others do to typical approaches in parenting, teaching, treatment, discipline* Doesn’t seem to learn from mistakes* Has periodic outbursts that seem to come from nowhere & when they are over, the child is fine* Is erratic in performance
* Seems to “get it” one day & not the other* Is very verbal, often interrupting & appearing rude* Repeats the same negative behaviour & always surprised when in trouble
70
RECOGNIZING A POSSIBLE FASD IN AN INDIVIDUAL
A person might have an FASD if he or she:* Doesn’t follow multiple directions* Wants to do well but consistently “messes up”* Seems to not understand why he or she is in trouble* Can “talk the talk” but not “walk the walk”* Has the lowest number of points or stars or is on the lowest level fairly consistently* Has a history of substance use in the family
71
RECOGNIZING A POSSIBLE FASD IN A CAREGIVER
A caregiver might have an FASD if he or she:* Appears co-operative on the surface but doesn’t follow through* Doesn’t follow through on multiple directions/tasks* Doesn’t show up regularly at appointments on time* Doesn’t schedule &/or get the child to appointments* Appears to be neglectful or uncaring* Has co-occurring disorders* Has a history of substance use in the family* May be homeless
72
WHAT YOU CAN DO IF YOU SUSPECT AN FASD IN AN INDIVIDUAL
OR A CAREGIVER Change interventions to promote success
* One direction at a time* Provide support to help the person succeed
* Dependency & enabling are not necessarily “bad”
* Repetition, repetition, repetition…as a support* Identification of & building on strengths
Ask caregivers about the possibility of prenatal exposure* Ask in a way that promotes honesty* Talk about the importance on knowing in order to help the family best* Discuss alcohol use before knowing one is pregnant 73
TYPES OF RECOMMENDATIONS THAT MIGHT BE CONSIDERED
Environmental alterations* In various settings
Occupational, Speech & Language Pathology &/or Physiotherapy as needed
Classroom modifications Neuropsychological assessment Mentors Family support, including respite Linking families together
74
ADDITIONAL INTERVENTIONS TO CONSIDER
Art therapy* Identify creative talents of the individual
Animal assisted therapy* Utilizing animals for individuals with an FASD* Having individuals with an FASD train therapy animals
Sports programs with appropriate supports Mutual aid support groups Peer mentoring with support for both
individuals with an FASD & their families75
FINAL THOUGHTS TO KEEP IN MIND Flexibility is essential in addressing FASD
* Flexibility in eligibility for services* Flexibility in intensity & timing of services
Creativity in the identification of services needed for the individual to do his/her best
Identifying & supporting strengths & validating accomplishments is essential
The spectrum of FASD are much more common than many other disorders such as Autism* The incidence in systems of care is significantly higher* Most individuals with an FASD will not be diagnosed 76
FINAL THOUGHTS TO KEEP IN MIND
Correctly recognizing & addressing FASD (in terms of prevention & treatment) can reduce long-term costs
Correctly recognizing & addressing FASD can improve outcomes for individuals, families, agencies, systems & communities
It is impossible to work successfully in most settings without having a firm working knowledge of FASD
We need to foster interdependence
77
FINAL THOUGHTS TO KEEP IN MIND
We want to help people to succeed* Whatever it takes is an important attitude* Ask the question “what does the person need in order to be successful (function at their best) & how do we help them to achieve that* Positive outcomes fir the person means positive outcomes for individuals, families, agencies, systems & communities
FASD is a human issue78
FASD IS A HUMAN ISSUE
FASD is about people; do not lose sight of that FASD affects the lives of individuals, families,
agencies, systems & communities It’s essential “to really care” People with FASD & their families have great
potential We need reminders of what has been
accomplished* Especially when things are not going well
Always remember that addressing FASD can be a matter of life & death* What you do concerning this issue can save lives!
79
RESOURCES IN THE CITY OF THUNDER BAY
Nor West Community Health Centre* www.norwestchc.org
Thunder Bay Indian Friendship Centre* www.tbifc.com
80
