1. My Drug Exposed Infant Is Growing Up. Now What?! Sean Maloney, M.A.,LMHC

2. Outline Characteristics of Drug Exposed Infants Factors Influencing Effects of Prenatal Exposure Childhood Symptoms Interventions

3. Characteristics of Drug Exposed Infants http://www.cnn.com/2012/04/28/health /drug-babies Higher risk for: Prematurity Low Birth Weight Small head circumference

4. Neuro-Behavioral Characteristics Irritability Tremors Difficult to console Increased muscle tone Decreased muscle tone Difficulty regulating state/rapid state changes

5. Characteristics Unresponsiveness Prolonged crying, high-pitched crying Easily over stimulated Feeding problems

6. Characteristics Sleeping problems Gaze aversion Excessive yawning and/or sneezing Difficulty regulating body temperature. Relatively rare.

7. Factors Influencing Effects of Prenatal Exposure Drugs of Choice Purity - Concentration - Toxins - Method of delivery

8. Factors When taken in pregnancy How long taken - Mother’s tolerance - General physical health

9. Factors Fetal levels - Does it cross the placental barrier? - Fetal metabolism

10. Childhood Symptoms Infant Symptoms Irritability Tremors Difficult to console Increased or decreased muscle tone Difficulty regulating state/ rapid state changes Sleep problems Childhood Symptoms Chronic irritability Tremors Difficulty modulating emotions Fine and gross motor delays Sleep disturbances Sleep problems I

11. Childhood Symptoms Prolonged crying/ high- pitched crying Easily over stimulated Feeding problems Gaze aversion Excessive yawning and/or sneezing Childhood Symptoms Tantrums that escalate Easily over stimulated Tactile sensitivity Poor eye contact Eyes glazed, spacey look, shut down Infant Symptoms

12. Interventions The Environment is crucial!

13. Seven Components of Environment Attitudes Perceptions Physical Layout Sensory Stimuli Timelines/Transitions Expectations Processes

14. Attitudes Provide structure not control Assumptions Support the child’s strengths and focus one these!

15. Perceptions Misinterpretation vs. Misbehavior. Remember that functioning can vary across different developmental areas. Look at behavior as the child’s way of attempting to meet a need. Help them learn how to describe emotions.

16. Physical Layout (or How To Set Up A Household) It’s all about balance. Think safety, organization, consistency, and predictability but NOT rigidity.

17. Physical Layout Provide a quiet space. Avoid visual “clutter”. Think about how you feel in a chaotic space. Visual reminders or cues can often be helpful. Defining space and boundaries is vital.

18. Sensory Stimuli Stimulating a child’s brain is always a balancing act. Gradually build up capacity for stimulation. Sunglasses, earphones can be helpful for screening out overstimulation. HALT/stress

19. Timelines/Transitions Give one direction. Complete. Then give next direction. Pay attention to transitions. Predicatbility = Safety and Security.

20. Expectations Consistency is the key! Flexibility continues to be a key concepts as we help these children and adolescents succeed! Be concrete. Kidding may not be understood. Self-regulation is the ultimate goal.

21. Processes Set them up for success! Model desired behavior in a concrete way. Predictability continues to be key. Avoid power struggles. Transitions like bedtime require special attention.

22. Processes Reduce surprises Educate those around them about the child’s strengths and challenges. Keep expectations reasonable and realistic.

23. In Closing Self care – How do you spell relief? Community – Keeps life in perspective. Share success stories! What are my child’s strengths?