1. Stade 2008 www.faseout.ca Secondary Disabilities and Fetal Alcohol Spectrum Disorder Dr. Brenda Stade, PhD, APN St. Michael’s Hospital, Toronto.

2. Stade 2008 www.faseout.ca Introduction: Secondary Disabilities Often secondary disabilities emerge in adolescence and adulthood Secondary disabilities are believed to result from complications of undiagnosed or untreated primary disabilities

3. Stade 2008 www.faseout.ca Introduction: Secondary Disabilities Mental health problems Disrupted school experiences Easily victimized Trouble with the law Confinement

4. Stade 2008 www.faseout.ca Introduction: Secondary Disabilities (cont.) Inappropriate sexual behaviour Alcohol and drug problems Needing dependent living situations Problems with employment

5. Stade 2008 www.faseout.ca Secondary vs. Primary Disabilities Are they the same or are they different?

6. Stade 2008 www.faseout.ca Executive functions of the prefrontal cortex  working memory  planning  time perception  internal ordering  self- monitoring  regulation of emotion  motivation  inhibition

7. Stade 2008 www.faseout.ca Secondary vs. Primary Disabilities Impulsive and uninhibited Passive and withdrawn one minute, switching to volatile temper tantrums the next Unpredictable; may need 24 hour supervision Depression, Extreme Anxiety

8. Stade 2008 www.faseout.ca Secondary vs. Primary Disabilities Hyperactive in non-goal directed activity Unable to stay focused on task: to follow rules, finish household chores, school assignments or keep commitments Genuine innocence and detached attitude

9. Stade 2008 www.faseout.ca Secondary vs. Primary Disabilities Impulsive – sexually inappropriate, stealing “Short-sighted” May expect immediate gratification Engaging and charismatic yet creative at re- framing reality.

10. Stade 2008 www.faseout.ca Impact of FASD

11. Stade 2008 www.faseout.ca Experience of Living with FASD 10-year-old stated: “Learning is hard. The teachers don’t explain things (in a manner that allows her to understand).”

12. Stade 2008 www.faseout.ca Experience of Living with FASD 18-year-old stated: “They (teachers, employers) expected me to do things I couldn’t. I have a hard time doing some things. Others (kids his age) do things easier, get through work ….”

13. Stade 2008 www.faseout.ca Experience of Living with FASD 21-year-old stated: “It (FAS) really does effect quality of life. It affects, school working, friendships…. How does it affect me? Differently. I do things differently…..My brain is rewired differently (than others).”

14. Stade 2008 www.faseout.ca Experience of Living with FASD 8-year-old stated: “(It’s) hard, hard to keep out of trouble, and I am not that smart. Everybody makes fun of me.”

15. Stade 2008 www.faseout.ca Hope for Positive Outcomes 21 year old stated: “The disability happened, it’s a disadvantage. It is not a disability. I don’t like to use it as an excuse (for not participating in life)”.

16. Stade 2008 www.faseout.ca Hope for Positive Outcomes 19 year old stated: “I don’t have the best brain. … But it still works”.

17. Stade 2008 www.faseout.ca Protective Factors Being raised in a nurturing stable environment Diagnosis before age 6 Having a diagnosis of FAS rather than ARND (Streissguth et al., 2004)

18. Stade 2008 www.faseout.ca Interventions: Diagnosis

19. Stade 2008 www.faseout.ca Why Diagnose? New understanding leads to new strategies at home and other environments Opens doors for services Better medical management.

20. Stade 2008 www.faseout.ca Interventions: Psychosocial

21. Stade 2008 www.faseout.ca Interventions: Psycho-social Mental Health Programs – behavioural, social skill development Counselling: family doctors, social workers, nurses, adolescent paediatricians, psychiatrists, psychologists Support Groups

22. Stade 2008 www.faseout.ca Interventions: Psychosocial Activities that foster confidence and social development ? Medication

23. Stade 2008 www.faseout.ca Interventions: Learning

24. Stade 2008 www.faseout.ca Interventions: Facilitate Learning Psychological Assessment Modification of School/Job Training Programs: – Small Size of 8 to 10 – Individual Educational Plan – Resource Teacher – Job Coach

25. Stade 2008 www.faseout.ca Six Strategies for Teaching Individuals with FASD 1.Structure and routine is critical 2.Less talk and more multi-sensory learning opportunities 3.Be concrete and don’t assume anything. Teach and re-teach

26. Stade 2008 www.faseout.ca Six Strategies for Teaching Individuals with FASD 4.Facilitate language. Use specialists to help with language development. 5.Gross motor programming is important These students need to move. 6.Reduce stimulation, use visual cues.

27. Stade 2008 www.faseout.ca Interventions: Facilitate Job Success Work environment that is accepting of areas of weakness not just areas of strength Structure Supervision Modified Work Hours

28. Stade 2008 www.faseout.ca Interventions: Facilitate Independence Identify housing that matches the individuals needs Economic support and protection The “External Brain” A community that cares

29. Stade 2008 www.faseout.ca Interventions: Strategies for Success

30. Stade 2008 www.faseout.ca Strategies for Success Observe patterns of behaviours Identify strengths, skills and interests Reframe the interpretation of behaviours Provide structure rather than control Establish routines and consistency

31. Stade 2008 www.faseout.ca Strategies For Success Build transitions into every routine Model behaviours Provide simple instructions or cues Identify behaviours which indicate the accumulation of frustrations Help develop skills for expressing feelings

32. Stade 2008 www.faseout.ca Strategies for Success Provide specific support for social skill development Understand the various forms of communications Include as many sensory modalities as possible to facilitate integration of information and experience

33. Stade 2008 www.faseout.ca Strategies for Success Consider information processing abilities Reevaluate expectations and goals for the individual: Clarify whose needs are being met by the goals Clarify goals and values for education/job training and independence

34. Stade 2008 www.faseout.ca Strategies for Success Advocate - Anticipate - Co-ordinate – Accept Integration of culturally relevant values and traditions Environment

35. Stade 2008 www.faseout.ca Thank you!