1. FETAL ALCOHOL SYNDROME FETAL ALCOHOL EFFECTS What Is It? Presented by: Linda R. Hamilton, LPC, LMFT for Charlottesville Health Summit 2010 1

2. It It is the leading cause of a wide range of birth defects and developmental disorders, particularly intellectual disabilities. (Some babies born with FAS or FAE, however, have normal IQ’s; some are higher than normal. It is caused a woman’s use of alcohol during pregnancy. It is not caused by any other event. It is 100% preventable! (Reportedly, over 75% of women of child-bearing age drink alcohol.) 2

3. CHARACTERISTICS OF INDIVIDUALS WITH FAS/E Intellectual disabilities Damage to the central nervous system Facial malformations (FAS only) – Thin upper lip – Narrow eye spaces – Low bridge of nose; usually short, broad, and flat with upturned nostrils – Minor ear abnormalities (usually small and malformed) – Abnormally small jaw – No indentation on upper lip 3

4. CHARACTERISTICS (continued) Failure to thrive (attachment disorder) Developmental delays (slow walking, talking, crawling, acting younger than age) Learning disabilities Memory problems (difficulty storing & retrieving information) Ability to repeat instructions but inability to translate into action Cognitive processing deficits (may think slowly) Slow auditory pace (may only understand every 3 rd word) Hyperactivity 4

5. CHARACTERISTICS (continued) Difficulty with abstractions (time, money, hypotheticals) Disturbed sleep patterns Processing errors – difficulty translating information from one sense to another (hearing into doing; thinking into saying; reading into speaking; feeling into words) – inconsistent mastery – are like telephone answering machines; can repeat but not change – difficulty generalizing information; gaps in association – difficulty in predicting outcomes/consequences – a rule is a rule is a rule … once learned, a rule cannot be changed 5

6. CHARACTERISTICS (continued) – Inflexible thought patterns – Problems distinguishing fantasy from reality – Difficulty distinguishing between friends and strangers – Socially inappropriate; often intrusive – Difficulty grasping laws of cause and effect Often volatile and/or rageful Very high rates of substance abuse 6

7. FOUR MAJOR AREAS OF DIFFICULTY 1.Translating information from one sense or modality into appropriate behavior. – Hearing into doing – Thinking into saying – Reading into speaking – Feelings into words What Does this Mean: Telephone answering machines—can repeat word for word what you say, then go off and do something different. Can “talk the talk” but not “walk the walk.” Behaviors do not match their words. Expressive language is better than receptive language. Sheer amount of speech may mask shallowness of content or lack of connectedness with behavior. Inconsistent mastery. What is learned on Monday may be forgotten by Wednesday. Test 100% on Monday; 25% on Wednesday. 7

8. FOUR MAJOR AREAS OF DIFFICULTY (continued) 2.Difficulty generalizing information. – A rule is a rule is a rule…you cannot change the rule once made and learned. It is cast in stone. – A rule at home (Don’t hit) may have to be re-taught at work. – Learning is done in isolation: Don’t ride your bike in the street needs to be taught for each street. – May wear heavy winter clothing on a hot summer day. No association is made between weather and temperature and clothing. – Inflexibility of thought. Cannot substitute words with similar meanings. For example, a hand-written “7” and a typed “7.” – Difficulty predicting outcomes or consequences. 8

9. FOUR MAJOR AREAS OF DIFFICULTY (continued) 3.Difficulty in perception. – Problems distinguishing fantasy from reality. TV events are often seen as real. Cartoon characters are viewed as real—if Superman can fly, so can I. – Difficulty distinguishing between friends and strangers – Trouble evaluating differences/changes in environment. – Difficulties with abstraction: math, money, time – Always in the “now” Telling time is very problematic. – Often socially inappropriate; have difficulty reading social cues, particularly non-verbal ones. 9

10. FOUR MAJOR AREAS OF DIFFICULTY (continued) 4.Alcohol and other drugs. It is essential that intervention services are begun early. Once an individual with FAS/E becomes addicted it is very difficult to provide enough stability in their adult lives to help them enter into recovery. Motivation becomes a key issue. Many adults with FAS/E also have babies who are prenatally exposed. Unfortunately, these babies often do not come to the attention of Child Protective Services early enough to prevent serious attachment disorders. 10