Banksia Hill FASD and neurodevelopmental Impairments project

Slides:



Advertisements
Similar presentations
Request Dispatching for Cheap Energy Prices in Cloud Data Centers
Advertisements

SpringerLink Training Kit
Luminosity measurements at Hadron Colliders
From Word Embeddings To Document Distances
Choosing a Dental Plan Student Name
Virtual Environments and Computer Graphics
Chương 1: CÁC PHƯƠNG THỨC GIAO DỊCH TRÊN THỊ TRƯỜNG THẾ GIỚI
THỰC TIỄN KINH DOANH TRONG CỘNG ĐỒNG KINH TẾ ASEAN –
D. Phát triển thương hiệu
NHỮNG VẤN ĐỀ NỔI BẬT CỦA NỀN KINH TẾ VIỆT NAM GIAI ĐOẠN
Điều trị chống huyết khối trong tai biến mạch máu não
BÖnh Parkinson PGS.TS.BS NGUYỄN TRỌNG HƯNG BỆNH VIỆN LÃO KHOA TRUNG ƯƠNG TRƯỜNG ĐẠI HỌC Y HÀ NỘI Bác Ninh 2013.
Nasal Cannula X particulate mask
Evolving Architecture for Beyond the Standard Model
HF NOISE FILTERS PERFORMANCE
Electronics for Pedestrians – Passive Components –
Parameterization of Tabulated BRDFs Ian Mallett (me), Cem Yuksel
L-Systems and Affine Transformations
CMSC423: Bioinformatic Algorithms, Databases and Tools
Some aspect concerning the LMDZ dynamical core and its use
Bayesian Confidence Limits and Intervals
实习总结 (Internship Summary)
Current State of Japanese Economy under Negative Interest Rate and Proposed Remedies Naoyuki Yoshino Dean Asian Development Bank Institute Professor Emeritus,
Front End Electronics for SOI Monolithic Pixel Sensor
Face Recognition Monday, February 1, 2016.
Solving Rubik's Cube By: Etai Nativ.
CS284 Paper Presentation Arpad Kovacs
انتقال حرارت 2 خانم خسرویار.
Summer Student Program First results
Theoretical Results on Neutrinos
HERMESでのHard Exclusive生成過程による 核子内クォーク全角運動量についての研究
Wavelet Coherence & Cross-Wavelet Transform
yaSpMV: Yet Another SpMV Framework on GPUs
Creating Synthetic Microdata for Higher Educational Use in Japan: Reproduction of Distribution Type based on the Descriptive Statistics Kiyomi Shirakawa.
MOCLA02 Design of a Compact L-­band Transverse Deflecting Cavity with Arbitrary Polarizations for the SACLA Injector Sep. 14th, 2015 H. Maesaka, T. Asaka,
Hui Wang†*, Canturk Isci‡, Lavanya Subramanian*,
Fuel cell development program for electric vehicle
Overview of TST-2 Experiment
Optomechanics with atoms
داده کاوی سئوالات نمونه
Inter-system biases estimation in multi-GNSS relative positioning with GPS and Galileo Cecile Deprez and Rene Warnant University of Liege, Belgium  
ლექცია 4 - ფული და ინფლაცია
10. predavanje Novac i financijski sustav
Wissenschaftliche Aussprache zur Dissertation
FLUORECENCE MICROSCOPY SUPERRESOLUTION BLINK MICROSCOPY ON THE BASIS OF ENGINEERED DARK STATES* *Christian Steinhauer, Carsten Forthmann, Jan Vogelsang,
Particle acceleration during the gamma-ray flares of the Crab Nebular
Interpretations of the Derivative Gottfried Wilhelm Leibniz
Advisor: Chiuyuan Chen Student: Shao-Chun Lin
Widow Rockfish Assessment
SiW-ECAL Beam Test 2015 Kick-Off meeting
On Robust Neighbor Discovery in Mobile Wireless Networks
Chapter 6 并发:死锁和饥饿 Operating Systems: Internals and Design Principles
You NEED your book!!! Frequency Distribution
Y V =0 a V =V0 x b b V =0 z
Fairness-oriented Scheduling Support for Multicore Systems
Climate-Energy-Policy Interaction
Hui Wang†*, Canturk Isci‡, Lavanya Subramanian*,
Ch48 Statistics by Chtan FYHSKulai
The ABCD matrix for parabolic reflectors and its application to astigmatism free four-mirror cavities.
Measure Twice and Cut Once: Robust Dynamic Voltage Scaling for FPGAs
Online Learning: An Introduction
Factor Based Index of Systemic Stress (FISS)
What is Chemistry? Chemistry is: the study of matter & the changes it undergoes Composition Structure Properties Energy changes.
THE BERRY PHASE OF A BOGOLIUBOV QUASIPARTICLE IN AN ABRIKOSOV VORTEX*
Quantum-classical transition in optical twin beams and experimental applications to quantum metrology Ivano Ruo-Berchera Frascati.
The Toroidal Sporadic Source: Understanding Temporal Variations
FW 3.4: More Circle Practice
ارائه یک روش حل مبتنی بر استراتژی های تکاملی گروه بندی برای حل مسئله بسته بندی اقلام در ظروف
Decision Procedures Christoph M. Wintersteiger 9/11/2017 3:14 PM
Limits on Anomalous WWγ and WWZ Couplings from DØ
Presentation transcript:

Banksia Hill FASD and neurodevelopmental Impairments project Australasian Youth Justice Conference 2016 Noni Walker

THANKS TO Young people at Banksia Hill and their Families Banksia Hill Detention Centre staff Department of Corrective Services Department for Child Protection and Family Support This presentation cannot be considered as either endorsed by the Department of Corrective Services or an expression of the policies or view of the Department of Corrective Services Any errors of omission or commission are the responsibility of the Researchers Project funded by NHMRC

Aims of Alcohol and Pregnancy and FASD Research Program: Reduce alcohol consumption in pregnancy Improve clinical practice and diagnosis of FASD Support appropriate therapies, management and services for children with FASD and their families 1. Prevention Midwives’ survey 93% asked about alcohol; 99% advised no alcohol; 93% wanted professional development 3M FASD Prevention project Marulu: prevention strategy in the Fitzroy Valley Midwives: A workforce intervention up-skilling midwives in use of AUDIT-C and brief intervention Mass Media: advertising campaign using Evaluated general population TV ads Aboriginal specific radio and TV ads 2. Diagnosis Australian diagnostic instrument developed by Australian FASD Collaboration FAS, PFAS, ND-AE Feasibility trial – in field now of instrument of guidelines for use of instrument of guidelines for support and referral for families On-line training module – in development National implementation and evaluation of instrument 3. Management National Disability Insurance Agency – review of research evidence on interventions, services and supports for FASD The Alert program® (NHMRC project grant) Primary school-based RCT for Aboriginal children in Fitzroy Valley Children taught to change level of alertness Improve self-regulation and executive functioning Family, teacher and therapist support

Outline What do we already know about FASD, neurodevelopmental impairment and youth justice? What is the Banksia Hill project adding to the evidence base? How is evidence from the Banksia Hill project making a difference to practice?

In Australia Women 18 – 44 years: 10% more than 2 standard drinks every day 45% more than 4 standard drinks on at least 1 occasion How many drinks during pregnancy? Of those who did consume alcohol after knowing they were pregnant, most (96%) reported usually consumed 1–2 standard drinks. NDSHS 2013 (National Drug Strategy household Survey) Why do women drink during pregnancy? Lack of knowledge about the effects of alcohol on the fetus Having a partner or friend who drinks Remote residence Low socioeconomic and educational status Living in a community tolerant of heavy drinking Unemployment

Advice on alcohol in pregnancy No alcohol in pregnancy is the safest choice National Health & Medical Research Council Guidelines on Alcohol Use www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/ds10-alcohol.pdf

Alcohol and the placenta Alcohol is a teratogen – it interrupts or alters the normal development of the fetus including the development of the brain and major organs Other teratogens include: rubella radiation mercury thalidomide Blood alcohol content – Alcohol is metabolized at the rate of .015 of blood alcohol concentration (BAC) every hour. A person with a very high BAC of .15 will have no measurable alcohol in the bloodstream after ten hours (.15 divided by .015 = 10) Is there a safe time or amount to drink? Timing When during the development Frequency How often was there exposure Quantity How much at each exposure

Fetal Development

Facial Features Majority of children and young people with a FASD will not have the facial features Palpebral fissures (short eye openings) Smooth philtrum (space between nose and upper lip) Thin upper lip

FASD Brain

FASD Brain

FASD and other neuro-developmental impairments are “hidden disabilities”

FASD Primary Disabilities: Secondary Effects: Memory and learning deficits Attention problems Deficits in abstract thinking (maths, money and time) Difficulty processing, storing & retrieving information Inability to make decisions Impulsivity, hyperactivity & distractibility Slower auditory pace Increased agitation, irritability and aggression Inability to understand cause & effect (particularly when relating actions to consequences) Difficulty understanding social expectations and personal space Secondary Effects: Trouble with the law Trouble at school Mental illness Reduced self-esteem Substance abuse Unemployment Homelessness Lack of education Inappropriate sexual behaviour Often lead to Person with FASD has slowed cognitive functioning (thinking pace) – may say I don’t know, appear to ‘shut down’ or need minutes to generate answer rather than seconds Memory impairment means difficulty in learning from past mistakes and often the same mistakes are made over and over again despite increasingly severe consequences Inconsistent memory or performance means remembering a task for 2 days and then forgetting the task on the 3rd day Inconsistent performance contributes to labelling the person as belligerent, wilful or not trying May only pick up pieces of information or instructions (slower auditory pace) – need to give 1 direction or instruction at a time Ability to repeat rules/instructions but inability to put them into action/apply these rules May talk excessively but unable to have meaningful exchange Perseveration - Person with FASD may have problems switching thoughts, stopping activities or moving onto a new task and often reacts strongly to changes in setting, program or personal Judgement, cause and effect reasoning requires abstraction Common for person with FASD to experience difficulties in conceptualising time, understanding mathematical concepts and/or value of money Inability to recognise danger or distinguish danger from safety, friend from stranger, fantasy from reality Person with FASD may be overwhelmed by sensory input and unable to filter out extraneous stimuli Increased agitation, irritability, and aggression Some underact to pain, others tactile stimulation can be an issue

FASD and trauma Children and young people with a FASD may have experienced prenatal substance exposure poor diet or malnutrition multiple placements neglectful, chaotic or abusive home environments This can lead to trauma and/or attachment issues that have impact on children’s brains A combination of trauma and FASD will significantly increase neurodevelopmental & neurobehavioural challenges than trauma alone More intellectual, cognitive and behavioural challenges for children or young people with trauma and FASD More intellectual and cognitive challenges for children/young people with trauma/FASD Most significant differences attention memory expressive and receptive language Children and young people with trauma/FASD and trauma/no FASD are more likely to be reported as being: oppositional hyperactive restless/impulsive inattentive socially inept They also have more behavioural problems than the general population

Developmental differences Developmental age does not equate to chronological age

Young people with FASD Chronological age 18 years on the verge of independence has a plan for their life budgets their money organises, accomplishes tasks at home, at school or in job Developmental age 18 going on 10 needs structure and advice lives in the “now”, little ability to project works better with an allowance needs to be organised by adults Yukon Education, Making a difference 2006 www.education.gov.yk.ca/pdf/publications/fasd_manual_2007.pdf

Young people with FASD find themselves constantly in trouble without understanding why Information processing deficits can lead to their behaviour being misinterpreted - examples More examples included in handout Yukon Education, Making a difference 2006 www.education.gov.yk.ca/pdf/publications/fasd_manual_2007.pdf

FASD and justice Children and young people with FASD can be involved in high risk, socially unacceptable and harmful behaviours and are at high risk of engaging with the justice system. International research: 2013 review reported rates for people in prison and correctional facilities considered to be at high risk of FASD at 98 to 233 per 1,000 Canadian data – 23% youth in juvenile detention had a diagnosis of FASD Systematic review - 19x greater risk of person with FASD to be incarcerated

What is the Banksia Hill project adding to the evidence base? Providing an estimate of the prevalence of FASD and other neurocognitive impairments among young people in detention in WA Identifying range and frequency of neurocognitive impairments among sentenced young people at Banksia Gaining an understanding of the impact of the project for young people and their families, Banksia staff, others in YJS, staff from Child Protection and Family Support (CPFS) Exploring existing management strategies that have positive outcomes for young people and staff at Banksia and developing new strategies in collaboration with YJS staff and young people LATER … Designing a FASD screening tool for use in community YJS settings

Assessments Multi-disciplinary diagnostic team comprising paediatrician, occupational therapist, speech pathologist and neuropsychologist Project researcher also collates family information including prenatal alcohol exposure if available and takes a photo of the young person’s face Diagnostic criteria from the Australian Diagnostic Instrument are used to identify FASD Neurodevelopmental impairments and other conditions (Intellectual Disability / ADHD / Autism) may be identified Consequences of undiagnosed FASD Broad and far reaching effects Undiagnosed FASD adversely affects their development Loss of education Loss of opportunities In turn affects whole families and the wider community Increased costs of health Increased costs of welfare services Reduced educational opportunities Reduced employment Comorbidity with other disorders: Autism share similarities with regard to social and communicative functioning children & adolescents with FASD/ASD significantly more behaviour problems FASD/ASD comorbidity 25%-30% ASD may ‘hide’ FASD and diagnosis of ASD more acceptable and expedient for receiving school support ADHD most frequent comorbidity of FASD 60% ADHD diagnosis 94% of children & adolescents with heavy alcohol exposure impairment of executive function may be a common underlying factor in ADHD and FASD children with FASD have difficulties with encoding and shift, and children with ADHD without FASD have problems with focus and sustain Medications Complex cognitive and psychological deficits often predispose affected individuals to a higher degree of sensitivity to medication, increased risk of over medication, susceptibility to changes in dosing and responses to certain drugs Use of SSRIs in children & adolescents with FASD does not hold and can lead to unmask a bipolar diathesis There is weak evidence that children with FASD and ADHD may have a better response to dexamphetamine than methylphenidate (Ritalin) Management of inattention and hyperactivity may improve learning and ameliorate the common secondary disabilities associated with FASD

Assessments for FASD – more detail search for “Banksia Hill FASD protocol paper” Study protocol for screening and diagnosis of fetal alcohol spectrum disorders (FASD) among young people sentenced to detention in Western Australia Passmore H, Giglia R, Watkins R, Mutch R (et al) BMJ Open June 2016

How is evidence from the Banksia Hill project making a difference to practice? building evidence to support the Western Australian 2015-2018 Youth Justice Framework assisting individual young people in WA: while in the detention centre; planning for release; on release orders in the community; in education, training, at work and socially in the community building future capacity of Youth Justice Services staff in WA to expand understanding and implementation of person-centred care building future capacity of Child Protection and Family Support staff in their therapeutic care for young people in WA involved with the YJS workforce development resources will be made available nationally (from 2017)

2015-2018 Youth Justice Framework Western Australia Department of Corrective Services Building the evidence base to support to transformational change

young people and families Young person gives assent, family consents, info from social and clinical assessments considered by multi-disciplinary team, MAY or MAY NOT have FASD or other neurodevelopmental impairment identified - all receive a report with: Strengths and Difficulties Strategies and Recommendations

Summary report for Department of Corrective Services database records Domain Strength Difficulty Impaired Cognition (visual & verbal thinking & problem solving)  Attention/Sensory (paying attention, processing sensory info) Executive Function (multi-tasking, inhibition, working memory, reasoning) Memory (memory of information over time) Visual memory Language (understanding and using verbal language, verbal reasoning and verbal short term memory) expressive receptive Motor Skills (gross and fine motor, balance) Academic Skills (maths, reading, writing, spelling) literacy maths

Example 1 - notes in a report Strengths and Difficulties Is a bright young person who may perform better on practical tasks that follow a step-by-step procedure Has difficulty remembering longer pieces of heard information Strategies recommended If possible, break down instructions to include only 2 parts. When longer instructions are necessary, repeat them and check that he is able to repeat the instructions in his own words.

Example 2 - notes in a report Strengths and Difficulties Has strong language skills in areas such as vocabulary, semantics (meanings of words and concepts) and stories using written language. Has difficulty presenting large amounts of information verbally and understanding non-literal language. Has difficulty with reading comprehension and spelling Strategies recommended Language Reading, comprehension and spelling

Example 2 cont - notes in a report Language If he is required to present larger pieces of information verbally, such as for a school task, allow him time to prepare and practice it. Encourage him to write it out first to make sure he has included all the information he wants to include. Encourage him to write down his sentences and extend them with more complex connectives such as ‘neither’, ‘however’, ‘although’, ‘unless’.

Example 2 cont - notes in a report Reading, comprehension and spelling Implementing programs such as ‘Language! A Literacy Intervention Curriculum’ might be beneficial in improving his reading skills. This program teaches reading as part of an enriched total language experience that integrates reading, writing, spelling, grammar, language use, and vocabulary. The program also offers an intensive professional development program for teachers. Encourage him to check and double-check work, as well as use a pencil and eraser to allow for quick correction of mistakes. Enable him to use a portable electronic spell checker (preferably one that includes games, as well as spell- checking capabilities) and work with crosswords, wordsearch puzzles, spelling board games and consider using a spelling tutor software package on a computer.

Example 3 - notes in a report Strengths and Difficulties Has skills in written language, able to express complex ideas in stories or notes, and as Hip Hop Has difficulty with expressive language, very limited verbal responses Strategies recommended Ask him to write descriptions of an event on post-it notes and give him time and space to place in time/location/person order Promote his song-writing by encouraging him to ask others to perform his works and create opportunities for performance

Example 4 - notes in a report Strengths and Difficulties His expressive language is slightly better than his receptive language. This will make him appear more able than he actually is, particularly because he is very social. He is very sensitive to noise. Strategies recommended Help him to understand information by making it clear and with simple steps (pictures and simple words). Place him at the front of the class and away from distractions. He may benefit from ear plugs to reduce noise impacts. Consider walking meetings – he likes to ‘move’ and likes physical activities.

FASD – not one size fits all Memory and learning deficits Attention problems Deficits in abstract thinking (maths, money and time) Difficulty processing, storing & retrieving information Inability to make decisions Impulsivity, hyperactivity & distractibility Slower auditory pace Increased agitation, irritability and aggression Inability to understand cause & effect (particularly when relating actions to consequences) Difficulty understanding social expectations and personal space Person with FASD has slowed cognitive functioning (thinking pace) – may say I don’t know, appear to ‘shut down’ or need minutes to generate answer rather than seconds Memory impairment means difficulty in learning from past mistakes and often the same mistakes are made over and over again despite increasingly severe consequences Inconsistent memory or performance means remembering a task for 2 days and then forgetting the task on the 3rd day Inconsistent performance contributes to labelling the person as belligerent, wilful or not trying May only pick up pieces of information or instructions (slower auditory pace) – need to give 1 direction or instruction at a time Ability to repeat rules/instructions but inability to put them into action/apply these rules May talk excessively but unable to have meaningful exchange Perseveration - Person with FASD may have problems switching thoughts, stopping activities or moving onto a new task and often reacts strongly to changes in setting, program or personal Judgement, cause and effect reasoning requires abstraction Common for person with FASD to experience difficulties in conceptualising time, understanding mathematical concepts and/or value of money Inability to recognise danger or distinguish danger from safety, friend from stranger, fantasy from reality Person with FASD may be overwhelmed by sensory input and unable to filter out extraneous stimuli Increased agitation, irritability, and aggression Some underact to pain, others tactile stimulation can be an issue

When working with people with FASD there are 8 Magic Keys to remember 1. Concrete 5. Simplicity 2. Consistency 6. Specific 3. Repetition 7. Structure 4. Routine 8. Supervision Deb Evensen & Jan Lutke (1997) http://www.fasalaska.com/8keys.html

Workforce development building future capacity of Youth Justice Services staff in WA to expand understanding and implementation of person-centred care building future capacity of Child Protection and Family Support staff in their therapeutic care for young people in WA involved with the YJS workforce development resources will be made available nationally (from 2017)

FASD Primary Disabilities: Secondary Effects: Memory and learning deficits Attention problems Deficits in abstract thinking (maths, money and time) Difficulty processing, storing & retrieving information Inability to make decisions Impulsivity, hyperactivity & distractibility Slower auditory pace Increased agitation, irritability and aggression Inability to understand cause & effect (particularly when relating actions to consequences) Difficulty understanding social expectations and personal space Secondary Effects: Trouble with the law Trouble at school Mental illness Reduced self-esteem Substance abuse Unemployment Homelessness Lack of education Inappropriate sexual behaviour Often lead to Person with FASD has slowed cognitive functioning (thinking pace) – may say I don’t know, appear to ‘shut down’ or need minutes to generate answer rather than seconds Memory impairment means difficulty in learning from past mistakes and often the same mistakes are made over and over again despite increasingly severe consequences Inconsistent memory or performance means remembering a task for 2 days and then forgetting the task on the 3rd day Inconsistent performance contributes to labelling the person as belligerent, wilful or not trying May only pick up pieces of information or instructions (slower auditory pace) – need to give 1 direction or instruction at a time Ability to repeat rules/instructions but inability to put them into action/apply these rules May talk excessively but unable to have meaningful exchange Perseveration - Person with FASD may have problems switching thoughts, stopping activities or moving onto a new task and often reacts strongly to changes in setting, program or personal Judgement, cause and effect reasoning requires abstraction Common for person with FASD to experience difficulties in conceptualising time, understanding mathematical concepts and/or value of money Inability to recognise danger or distinguish danger from safety, friend from stranger, fantasy from reality Person with FASD may be overwhelmed by sensory input and unable to filter out extraneous stimuli Increased agitation, irritability, and aggression Some underact to pain, others tactile stimulation can be an issue

The attached diagram is an overview of the ideal continuum of care for FASD intervention for communities.  It is based on expert consensus and literature review.  Over time, models are being developed for each part of this continuum of care by researchers and clinicians. A full evidence base has not yet been created.  Communities can view this diagram as a model of the services a community would ideally create for individuals with FASD or prenatal alcohol exposure, and the families who care for them.  Advocates can help by letting policy workers know what services are lacking in their community, or what research funding is needed to create an evidence base in FASD  intervention.  http://depts.washington.edu/fmffasd/FASD-ideal Families Moving Forward Program (for 3 – 13 yr olds involves 9-11 months of behavioural consultation and education sessions with parents) Some of the aims : Support parents and help them better understand their children who are affected by prenatal alcohol Give parents new skills and strategies to use when caring for their children with FASD Enable teachers and health care providers, as well as family members, to recognize the signs of FASD Train health care providers in evidence-based services they can offer to families with alcohol-affected children Encourage family progress in a positive direction Restore hope and optimism to families caring for children with FASD Reduce the chance that children affected by prenatal alcohol will have secondary disabilities later in life

Resources Telethon Kids Institute Alcohol, Pregnancy & FASD http://alcoholpregnancy.telethonkids.org.au/ Resources for justice professionals FASD & Justice http://alcoholpregnancy.telethonkids.org.au/fasd-justice 6 Videos – available from website under professional development http://alcoholpregnancy.telethonkids.org.au/fasd-justice/professional-development/ National Health & Medical Research Council Guidelines on Alcohol Use http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/ds10-alcohol.pdf e-learning modules for health professionals involved in FASD diagnosis http://alcoholpregnancy.telethonkids.org.au/australian-fasd-diagnostic-instrument/e-learning-modules/ Families Moving Forward Program http://depts.washington.edu/fmffasd/home

Want to know more? Noni Walker Banksia Hill Project Alcohol & Pregnancy & FASD Research Program Telethon Kids Institute Noni.Walker@telethonkids.org.au Visit our website: http://alcoholpregnancy.telethonkids.org.au/