1. Fetal Alcohol Spectrum Disorder
Sharing

2. Myth or Fact
Alcohol causes more damage to the developing baby than heroin does.
Drinking alcohol is only harmful to the baby during the first trimester.
If a mother drinks a lot and has a normal healthy baby then her second child will be ok if she continues to drink.
The effects that alcohol has on a newborn will gradually go away as the child gets older.
Women at the lowest income bracket are most at-risk to consume alcohol while pregnant.
10.8% of women drink in there pregnancies in Canada, women of the highest income bracket, it is 40.5%.
Told in St. Alberta by a principle in a school that there was no FASD in St.Albert, asked, what are the rates of ADHD or autism, are those higher?
We have to make sure we are asking the right questions in a non-judgemental, safe way.

3. Why Should We Talk About FASD?
Educating about FASD provides awareness of the condition as well as helps to dispel any myths or preconceptions about people with FASD.
Education on FASD is part of a holistic health approach that should be offered to all communities.

4. Misinterpretation Medical Personnel Human Services Staff/Caregivers
Justice Professionals
Teachers
Employers
Misinterpretation
- Ask participants their experience with others and themselves misinterpreting FASD

5. Essential Beliefs FASD is a permanent disability
Behaviour is a symptom of the disability
Don’t make assumptions about behaviour (uncooperative, defiant,…)
Natural and logical consequences may not work
Chronological age does not reflect developmental level
When we fail to accommodate, we create the disability

6. What We Believe
People who have Fetal Alcohol Spectrum Disorder (FASD) are capable.
Families need support
Women at-risk of having a child with FASD need our support
How we talk about FASD matters
There is HOPE

7. Brain-based, neurobehavioral disorder and life-long disability.
Wide variety of physical and functional symptoms with differing levels of severity.
No one physical, behavioral or psychological profile for a person who has an FASD.
Each individual will be affected by prenatal alcohol exposure in a different way and interventions that work with one child may not be successful with another.
What is FASD
A few of them may have birth defects.
Some of them have physical characteristics.
All of them have brain damage and neurobehavioral disorders.

8. Alcohol Use in Pregnancy*
While no amount of alcohol during pregnancy is safe, we know that heavy drinking (more than 7 drinks per week) and binge drinking (more than 5 drinks per sitting) are the most harmful to the developing baby.
The spectrum of alcohol use
An analogy that can be used to consider the risk factor. Is it possible to be intoxicated and drive home safely. Even though it feels politically incorrect the answer is yes, however why take that chance or repeat because the outcome was okay. The same with alcohol and pregnancy, research demonstrates that results can vary from person to person or even pregnancy to pregnancy.
Amount of Alcohol Used

9. Alcohol and the Developing Brain
To understand how and why FASD has such profound and varied effects, we must first look at the effects of alcohol on the developing fetus.
Alcohol is a teratogen – a toxin known to interfere with the development of a fetus.
Alcohol is especially damaging because it can cause problems with how cells are formed and arranged as the baby develops.
Prenatal exposure can also affect the size of the brain, formation of brain structures, neurochemistry and the function of the brain after birth.

10. Roadways of the Brain Normal brain development is complex
Yet within the complexity it is organized, sequential
When we add alcohol to brain development we have added a road block
Instead or orderly growth, we get undergrowth, overgrowth, tangles and gaps
Biological processes make sure that all the required cells are created and that those cells wind up where they are supposed to be in the body.
Prenatal alcohol exposure causes the processes of cell creation and cell migration to malfunction. Cells might have defects, may wind up in the wrong place or might not be created at all.

11. Neurological Effects of FASD
Children prenatally exposed to alcohol often display what doctors refer to as diffuse brain damage.
This means that the damage is widespread and impacts numerous areas. The diffuse nature of the brain damage that occurs with FASD may help to explain the large variety of symptoms and effects.

12. The human brain has a remarkable ability to compensate when an area is injured or damaged.
The ability of the brain to adapt and compensate for injury is called plasticity.
Early intervention programs and supportive home environments can promote increased plasticity for children affected by prenatal alcohol exposure.
As a caregiver, the most important thing you can do to support brain development is to provide a loving and supportive environment that nurtures the child’s unique talents and abilities
LETS TALK ABOUT WHAT IT MEANS TO PROVIDE A LOVING, SUPPORTIVE ENVRONMENT, WHAT DO YOU DO IN YOUR HOMES?
The Brain Can Adapt

13. Neurological Effects of FASD
As a caregiver for a child with an FASD, you can support the best possible outcome by providing a home environment with the following characteristics:
Safety
Security
Support
Consistency
Enrichment
Stability
- Group discussion how families can support each of these in their homes

14. Why Assess for FASD?
Creates a shared understanding among clinicians, as well as between clinicians, patients and caregivers.
Helps to access programs for support and intervention.
Validates the concerns of the individual, family and caregiver.
Helps women at risk and people with FASD get the help needed.
This discussion may also prompt participants to learn more about an assessment for themselves or creating awareness for others possibly impacted.

15. The Diagnosis FASD with Sentinel Facial Features
FASD without Sentinel Facial Features
At-Risk for Neurodevelopmental Disorder and FASD

16. Canadian Guidelines for Diagnosis of FASD Across the Lifespan
Prenatal Alcohol Exposure (PAE)
Medical Assessment: family history, maternal alcohol consumption, physical examination, differential diagnosis
Sentinel Facial Features
Neurodevelopmental Assessment
Special considerations in neurodevelopmental assessment of infants and young children
Special considerations when diagnosing adolescents and adults
Management and Follow-up
The Canadian guidelines have recently changed because gaps existed in the current standards
Revised guidelines are based on consensus, experience and science, they are consensus based
All assessments use a multidisciplinary team, core team members differ depending on the context and age of the individual being assessed
PAE (7 or more standard drinks per week, any episode of drinking 4 or more drinks on same occasion, 2 binge episodes)

17. Neurodevelopmental Assessment
Evidence of 3 or more impairments of the following CNS domains:
Motor Skills
Neuroanatomy/Neurophysiology
Cognition
Language
Academic Achievement
Memory
Attention
Executive Functioning, including impulse control
Affect Regulation
Adaptive Behaviour, social skills and social communication
Talk about each of these, ask for examples of impairments that participants have seen
Motor domain encompasses general abilities to use and coordinate large and small muscles. Gross motor skills include walking, running, hopping and climbing. Fine motor skills include hand writing and eating. Eye hand coordination refers to the ability to coordinate vision with movement.
Previous Domain “Brain Structure” Relating to the function and structure of the nervous system, this can affect fine and gross motors skills, ability to process sensory information, motor control, balance, rhythm, strength, motor planning and sequencing. This area also includes seizure disorders.
Cognition domain refers to the general level of thinking ability. An important facet of assessment in this domain is comparison of verbal with nonverbal thinking abilities.
COMMUNICATION: Expressive is stronger than receptive, can express language but does not comprehend what is being communicated.
Achievement domain assesses skills in core academic areas-reading, math, and written language. A primary focus includes comparison of the child's academic skills to their own intellectual potential and to their peer’s abilities. Literacy, reading and comprehension. Missing societal markers.
Memory domain encompasses the capacity to consolidate, store, and retrieve information for short and long term application.
Appointments, describing incidents, tenancy and eviction agreements and unaware of trauma affects.
- Attention domain refers to the processing capacity for selective, focused, sustained, and flexible attention, as seen, for example, in behaviors of concentration, hyperactivity and impulsivity.
- Social Communication domain refers to the ability to communicate
appropriately and effectively in a variety of social situations with both
peers and adults, including the ability to relay verbal information
coherently and cohesively. Adaptation refers to the degree to which a
person is able to meet the challenges of daily living when compared
to others their age.
ADAPTABILITY
Highest percentage of all the Domains affected for FASD

18. Developmental Vs. Chronological Age

19. Adverse Conditions Housing Mental Health Alcohol and Drug Use
Employment
Sexual Behaviour
Law
Adverse Conditions
Are those that a person is not born with.
These can be prevented or improved through better understanding and intervention.

21. Guidelines for Working with Individuals with FASD
Communicate using concrete language and examples.
Ask questions to check for understanding.
Alter the environment.
Be organized.
Have consistent routines.
Be clear with expectations and be consistent.
Remember the individual’s developmental age.
Keep it simple.
Slow down, allow time to adjust to new activities/environments.
Allow for lots of breaks.
Focus on strengths.
Connect individual with a support person.
Try different (ways), not try
harder.

22. How to Help an Individual with FASD be Successful
Have more people understand FASD.
Obtain an FASD assessment early.
Provide a stable, safe, structured, sober and nurturing home.
Involve affected individuals and family in plans – as abilities permit.
Develop supportive social networks.
Access support services for those affected by FASD.

23. Guiding Principles -from the Saskatchewan Prevention Institute
•Hope
•(supportive intervention makes a difference)
•Respect
•(for the abilities of all those with an FASD)
•Understanding
•(by staying open to new information and ideas)
•Compassion
•(by being sensitive to the needs of individuals and their families)
•Cooperation
•(by recognizing the importance of partnerships)

24. Alberta FASD Service Networks
Call or visit fasd.alberta.ca
to link to the FASD Service Network in your area.
The FASD Service Networks have been developed with community agencies, government organizations and local stakeholders, and are working together to provide a continuum of coordinated services across the lifespan. Networks provide a single point of access for prevention and awareness, assessment and diagnosis, and direct supports and services for individuals affected by FASD and their caregivers.
There are 12 Networks across the province, so there is one near you that you can connect with. Call for more information or visit fasd.alberta.ca.