1. Working with kids with Fetal Alcohol Spectrum Disorders (FASD)

2. MN Organization on Fetal Alcohol Syndrome 2 FASD Timeline Feb 2013

3. MN Organization on Fetal Alcohol Syndrome 3 US Map– Centers for Disease Control, 2010 Feb 2013

4. Minnesota Pregnancy Drinking Statistics Almost half of pregnancies are unplanned (contraception failure or lack of use), 28% of births are unplanned. (Henshaw, 1998) 20% of pregnant women continue to drink after finding out they are pregnant. (Stratton et al 1996) In MN, about 12% of women consume five or more drinks per month during pregnancy. (Taking A Closer Look MDH 2002) In MN, about 5% binge-drink (5 or more drinks at a time) during pregnancy. (Taking A Closer Look MDH 2002) MN Organization on Fetal Alcohol Syndrome 4Feb 2013

5. What are the facts? Alcohol use during pregnancy does not always result in FASD Most children with FASD go undiagnosed MN Organization on Fetal Alcohol Syndrome 5Feb 2013

6. An Under-Identified Disorder More Common than Autism Leading cause of intellectual disability in North America FASD occurs in all racial, ethnic and socioeconomic groups Often misdiagnosed due to lack of information and awareness (See Overlapping Characteristics) DSM barrier 100% Preventable MN Organization on Fetal Alcohol Syndrome 6 Incidence of fetal alcohol spectrum disorders– Minnesota Statistics - CDC 2006; National Statistics - March of Dimes; NOFAS 2004. Feb 2013

7. What are Fetal Alcohol Spectrum Disorders (FASD)? A set of physical, behavioral, and cognitive disorders seen in individuals exposed to alcohol prenatally Lifetime disability with brain injury that never goes away Broad range (spectrum) of characteristics that vary from person to person MN Organization on Fetal Alcohol Syndrome 7Feb 2013

8. MN Organization on Fetal Alcohol Syndrome 8 The FASD Umbrella Fetal Alcohol Spectrum Disorders  Fetal Alcohol Syndrome (FAS)  Partial Fetal Alcohol Syndrome (pFAS)  Fetal Alcohol Effects (FAE) replaced by ARBD & ARND in 2006  Alcohol-Related Birth Defects (ARBD)  Alcohol-Related Neurodevelopmental Disorder (ARND) Feb 2013

9. Areas of Diagnostic Evaluation 1.Facial Dysmorphia 2.Growth Problems 3.Central Nervous System Abnormalities 4.History of Maternal Alcohol Exposure MN Organization on Fetal Alcohol Syndrome 9Feb 2013

10. MN Organization on Fetal Alcohol Syndrome 10 FAS Facial Characteristics Thin upper lip Palpebral fissures Smooth, long philtrum CDC 2004 Might also have: Low set ears, flat mid-face, up-turned nose, small chin, and epicanthal folds. FAS Facial Characteristics – Image courtesy of FASTAR.. Feb 2013

11. FASD & the Brain

12. MN Organization on Fetal Alcohol Syndrome 12 National Organization on Fetal Alcohol Syndrome (NOFAS), 2004; Adapted from Moore, 1993. Feb 2013

13. Newborn Brain MN Organization on Fetal Alcohol Syndrome 13Feb 2013

14. Brain Damage Failure of certain brain regions (e.g., the corpus callosum) to develop Failure of certain cells to migrate to their appropriate locations during embryonic brain development A tendency for the tissue to die in some brain regions (e.g., the cerebellum) MN Organization on Fetal Alcohol Syndrome 14 Winter 2000 issue of Alcohol Research & Health Feb 2013

15. MN Organization on Fetal Alcohol Syndrome 15 Prenatal exposure to alcohol causes permanent brain injury that never goes away. Mattson, S.N.; Jernigan, T.L.; and Riley, E.P. 1994. MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1):49–52. Feb 2013

16. MN Organization on Fetal Alcohol Syndrome 16 Most Affected Areas of the Brain Feb 2013

17. Corpus Callosum Attention Intellectual function Executive functioning Learning MN Organization on Fetal Alcohol Syndrome 17Feb 2013

18. Cerebellum Movement, motor control Balance & equilibrium Muscle tone Ability to judge distances Involved in some cognitive processes MN Organization on Fetal Alcohol Syndrome 18Feb 2013

19. Basal Ganglia Can affect spatial memory and behaviors – Perseveration – inability to switch modes – work towards goals – predict behavioral outcomes Time perception MN Organization on Fetal Alcohol Syndrome 19Feb 2013

20. Frontal Lobes Impulse control Self regulation Executive Functions- – Linking 2 or more ideas together – Understanding abstract or complex concepts – Generalizing (ex. Learning to cross street) – Understanding cause & effect / consequences – Judgment MN Organization on Fetal Alcohol Syndrome 20Feb 2013

21. Prenatal Alcohol Exposure and Information Processing MN Organization on Fetal Alcohol Syndrome 21 input (taking information in from the senses) integration (interpreting information, making sense of it) memory (storing information for later use, connecting with previous experiences) output (response, behavior) Feb 2013

22. Look at the chart and say the color not the word YELLOW BLUE ORANGE BLACK RED GREEN PURPLE YELLOW RED ORANGE GREEN BLACK BLUE RED PURPLE LEFT-RIGHT CONFLICT Your right brain tried to say the color but your left brain insists on reading the word. MN Organization on Fetal Alcohol Syndrome 22Feb 2013

23. Strategies

24. Sensory Processing What is it exactly? Taking in and making sense of incoming data Having an appropriate response to the data received MN Organization on Fetal Alcohol Syndrome 24Spring 2013

25. Problems with Sensory Processing Under Responsive Excessive need to touch Spinning On the move Floppy Likes swinging Crashing Roughhousing Limited body space awareness Over Responsive Avoids touch Struggles when picked up Aversion to play dough Doesn’t like hair comb Doesn’t like barefoot Doesn’t like playground equipment Doesn’t like feet not on the ground MN Organization on Fetal Alcohol Syndrome 25Spring 2013

26. Intervention Strategy Ideas Calm and Quiet environment Limit number of objects on walls and hanging Calm Colors on Walls Define Spaces (eating, playing, resting) Establish rules for cleanup and transition MN Organization on Fetal Alcohol Syndrome 26Spring 2013

27. Intervention Strategies Quiet routine activities to help stay organized Sing small songs to help with routine activities Focus on cause and effect activities Increased language stimulation activities Set limits MN Organization on Fetal Alcohol Syndrome 27Spring 2013

28. Intervention Strategies Breaks instead of timeouts Define space around child – armrests, bean bags Teach relaxation Keep It Short and Simple Add movement to learning MN Organization on Fetal Alcohol Syndrome 28Spring 2013

29. Adapt the Environment MN Organization on Fetal Alcohol Syndrome 29 Slides Courtesy of Canada FASD curriculum. Spring 2013

30. Strategies for Transitions Timers Songs Picture schedules Establish routines Child with transition difficulty becomes the helper May need to avoid waiting in lines MN Organization on Fetal Alcohol Syndrome 30Spring 2013

31. Eight Simple Keys Concrete Consistency Repetition Routine Simplicity (KISS) Specific Structure Supervision Spring 2013 MN Organization on Fetal Alcohol Syndrome 31

32. Recognize Strengths! Friendly, cuddly, happy Caring, kind and loyal Curious and involved Energetic, hard working Fair and cooperative Artistic or musical Highly verbal Long term visual memory MN Organization on Fetal Alcohol Syndrome 32Spring 2013

33. Resources

34. MN FASD Diagnostic Clinics FASD Clinic; Essentia Health, Children’s Services Treehouse Psychology Native American Community Clinic Lakewood Health System FASD Diagnostic Clinic White Earth FASD Diagnostic Clinic Centra care FASD Clinic Bluestem Center Stillwater Medical Group MOFAS FASD Diagnostic Clinic Canvas Health FASD & Neurodevelopmental Disorders Diagnostic Clinic International Adoption Clinic – U of MN Spring 201334 MN Organization on Fetal Alcohol Syndrome Park Nicollet Diagnostic Clinic U of MN FASD Program HealthEast Behavioral Pediatrics Clinic

35. Online Resources General Information on FASD – Center for Disease Control and Prevention, FAS site http://www.cdc.gov/ncbddd/fas – FASD Unit @ the Univ of Washington School of Medicine http://depts.washington.edu/fadu/ – MOFAS Resource Directory – http://www.mofas.org MN Organization on Fetal Alcohol Syndrome 35 MN Organization on Fetal Alcohol Syndrome 35 Feb 2013

36. Don’t Try Harder Try Differently If you’ve told a child a thousand times and he still does not understand, then it is not the child who is the slow learner. - Walter Barbee MN Organization on Fetal Alcohol Syndrome 36Feb 2013

37. Contact Information: MOFAS Phone: 651-917-2370 www.mofas.org