Competancy Vb: Primary and Secondary Disabilities in Individuals with FAS through the Life Span © NORTHEAST REGIONAL FAS EDUCATION AND TRAINING CENTER.

Competancy Vb:Primary and Secondary

Disabilities in Individuals with FAS through the Life

Span

© NORTHEAST REGIONAL FAS EDUCATION AND TRAINING CENTER. 2006

What is FAS?

Fetal Alcohol Syndrome (FAS) is a life long birth defect caused by

maternal consumption of alcohol during pregnancy.

The Criteria for FAS

• The most sophisticated and reliable diagnostic system was developed at the University of Washington.

• The University of Washington system contains four components. The components are:– Altered facial characteristics – Altered growth pattern – Altered brain function– Maternal alcohol use during pregnancy

( Reprinted with permission, Streissguth A.P., & Little, R.E. 1994)( Reprinted with permission, Streissguth A.P., & Little, R.E. 1994)

Growth DeficiencyThe growth deficiency that characterizes FAS results from teratogenic insult, not postnatal environmental factors or chronic illness. The growth deficiency is consistent.

The most accurate measurements are typically made between the ages of 8 months to pre-adolescence.

Height is adjusted for age and gender, and when possible, for parental height. Weight is adjusted for age and gender.

For ranking purposes, the growth curve is separated into Prenatal growth Postnatal growth

Brain FunctionStructuralStructural

HCStructural (MRI/CT)

NeurologicSeizuresSeizuresGross motorGross motorFine motorFine motorQuick neurologic screeningQuick neurologic screeningOtherOther

PsychometricPsychometricCognitiveCognitiveAchievementAchievementAdaptationAdaptationPsychiatric DiagnosisPsychiatric DiagnosisNeuropsychologicalNeuropsychologicalLanguageLanguageMotorMotorMemoryMemory

Behavioral/Social Competence

Scoring Alcohol Exposure

4-Digit4-DigitDiagnostic Code Diagnostic Code

RankRank

GestationalGestationalAlcoholAlcohol

ExposureExposureCategoryCategory

DescriptionDescription

44 High RiskHigh Risk Alcohol use during pregnancy CONFIRMEDAlcohol use during pregnancy CONFIRMED

andandExposure pattern is consistent with the medical Exposure pattern is consistent with the medical literature placing the fetus at ‘high risk’ (generally high literature placing the fetus at ‘high risk’ (generally high peak blood alcohol concentrations delivered at least peak blood alcohol concentrations delivered at least weekly in early pregnancyweekly in early pregnancy

33 Some RiskSome Risk Alcohol use during pregnancy CONFIRMEDAlcohol use during pregnancy CONFIRMED

andandDrinking occurred in gestation in frequencies and Drinking occurred in gestation in frequencies and volumes less than in Rank (4) or exact amounts volumes less than in Rank (4) or exact amounts unknownunknown

22 Unknown RiskUnknown Risk Gestational exposure is simply not known or Gestational exposure is simply not known or information is of questionable reliabilityinformation is of questionable reliability

11 No RiskNo Risk Alcohol use during pregnancy is CONFIRMED to be Alcohol use during pregnancy is CONFIRMED to be completely ABSENTcompletely ABSENT

Deriving the 4-Digit Diagnostic Code Rank for Brain Function

4-Digit Diagnostic Code for FAS

Diagnosis: Diagnosis: (1)(1) Fetal Alcohol SyndromeFetal Alcohol Syndrome

(2) Alcohol Exposure(2) Alcohol Exposure

4-Digit Diagnostic Code for FAS4-Digit Diagnostic Code for FAS

4 4 4 34 4 4 3

Significant Severe Definite (4) (4) High Risk

Moderate Moderate Probable (3) (3) Some Risk

Mild Mild Possible (2) (2) Unknown

None None Unlikely (1) (1) (1) No Risk(1) No Risk

Growth Facial Brain Growth Face Brain Alcohol Gestational

XX XX XX

XX

Sex Differences in Sex Differences in Body MassBody Mass

The male with FAS is pictured at the ages of 5, 10, and 15. Note the classic FAS features in the child’s torso.Male children with FAS, typically, remain below average in weight and do not demonstrate the marked obesity observed for female children with FAS during adolescence.

FAS – Only the tip of the iceberg

Fetal Alcohol Spectrum Fetal Alcohol Spectrum Disorders- is the broad Disorders- is the broad spectrum of disorders caused by spectrum of disorders caused by prenatal exposure to alcohol prenatal exposure to alcohol including:including: FASFAS (Fetal Alcohol Syndrome) (Fetal Alcohol Syndrome) FAE (Fetal Alcohol Effects)FAE (Fetal Alcohol Effects) ARND (Alcohol Related ARND (Alcohol Related

Neuro-developmental Neuro-developmental Disorders)Disorders)

ARBD (Alcohol Related Birth ARBD (Alcohol Related Birth Defects)Defects)

FAS

FASD

FAE ARND

ARBD Partial FAS

Differential Diagnosis

If all three areas are affected and abnormalities If all three areas are affected and abnormalities are present, the disorder is FAS, are present, the disorder is FAS, with or with or withoutwithout alcohol confirmation. alcohol confirmation.Fetal Alcohol Spectrum Disorders (FASD) is Fetal Alcohol Spectrum Disorders (FASD) is defined by the presence of abnormalities in any defined by the presence of abnormalities in any of the areas, of the areas, withwith alcohol confirmation. alcohol confirmation.Diagnosis of FAS requires a trained physicianDiagnosis of FAS requires a trained physician

((National Organization on Fetal Alcohol Syndrome, National Organization on Fetal Alcohol Syndrome, 2006)2006)

Differential Diagnosis of Physical Features Found in Fetal

Alcohol SyndromeSyndromeSyndrome Similarities to FAS Similarities to FAS Differences from FASDifferences from FAS

Aarskog Aarskog syndromesyndrome

Ptosis, small upturned nose, broad Ptosis, small upturned nose, broad smooth philtrum, flat midface, mild smooth philtrum, flat midface, mild mental retardationmental retardation

Hypertelorism, brachydactyly, shawl Hypertelorism, brachydactyly, shawl scrotum, X-linked inheritancescrotum, X-linked inheritance

Williams Williams syndromesyndrome

Mild prenatal growth deficiency, Mild prenatal growth deficiency, microcephaly, mild mental microcephaly, mild mental retardation, short palpebral fissures, retardation, short palpebral fissures, upturned nose, long philtrumupturned nose, long philtrum

Aortic or pulmonary stenosis, hoarse Aortic or pulmonary stenosis, hoarse voice, high relative language voice, high relative language abilityability

Noonan Noonan syndromesyndrome

Short stature, mild mental retardation, Short stature, mild mental retardation, ptosis, upturned noseptosis, upturned nose

Webbed neck, low posterior Webbed neck, low posterior hairline, shield chest, pulmonic hairline, shield chest, pulmonic stenosis, cryptorchidismstenosis, cryptorchidism

Dubowitz Dubowitz syndromesyndrome

Prenatal growth deficiency, mental Prenatal growth deficiency, mental retardation, microcephaly, short retardation, microcephaly, short palpebral fissures, ptosispalpebral fissures, ptosis

High-pitched cry, eczema-like skin High-pitched cry, eczema-like skin disorder, limb anomalies, disorder, limb anomalies, cryptorchidism, ocular cryptorchidism, ocular abnormalitiesabnormalities

Differential Diagnosis of Physical Features Found in Fetal

Alcohol SyndromeSyndromeSyndrome Similarities to FASSimilarities to FAS Differences from FASDifferences from FAS

Bloom syndromeBloom syndrome Prenatal growth deficiency, Prenatal growth deficiency, microcephaly, flat midfacemicrocephaly, flat midface

Facial telangiectasia erythema, Facial telangiectasia erythema, pigmentation pigmentation abnormalities, tendency to develop abnormalities, tendency to develop malignancymalignancy

Fetal Hydantoin Fetal Hydantoin syndromesyndrome

Growth deficiency, occasional Growth deficiency, occasional mild mental retardation, ptosis, mild mental retardation, ptosis, short upturned noseshort upturned nose

Hypoplastic fingertips, digitalized Hypoplastic fingertips, digitalized thumb, short neck, hirsutism, low thumb, short neck, hirsutism, low hairlinehairline

Maternal Maternal phenylketonuria phenylketonuria fetal effectsfetal effects

Mental retardation, growth Mental retardation, growth deficiency, microcephaly, short deficiency, microcephaly, short palpebral fissures, flat philtrum, palpebral fissures, flat philtrum, thin upper lip, small upturned thin upper lip, small upturned nose, flat midfacenose, flat midface

Hypertonia, cardiac defects Hypertonia, cardiac defects

Differential Diagnosis of CNS and Behavioral Feature Found in Fetal

Alcohol SyndromeSyndrome Similarities to FAS Differences from FAS

Fragile X Fragile X syndromesyndrome

Attention problems, hyperactivity, Attention problems, hyperactivity, speech deficitsspeech deficits

Hand flapping, poor eye contact, Hand flapping, poor eye contact, more severe mental retardation, more severe mental retardation, autismautism

22q11 deletion 22q11 deletion syndromesyndrome

Learning disabilities, IQ range from Learning disabilities, IQ range from low normal to mild mental low normal to mild mental retardation, speech deficitsretardation, speech deficits

10% with psychiatric disorders, 10% with psychiatric disorders, strong social skillsstrong social skills

Turner syndromeTurner syndrome Low normal IQ, subtle deficits in Low normal IQ, subtle deficits in social skills, difficulties with math social skills, difficulties with math and problem-solving, 50% with and problem-solving, 50% with hearing impairmenthearing impairment

Better overall performance for Better overall performance for IQ levelIQ level

Opitz syndromeOpitz syndrome Mild-to-moderate mental retardationMild-to-moderate mental retardation Mental retardation is usually Mental retardation is usually accompanied by CNS structural accompanied by CNS structural deficitsdeficits

Common Disorders Identified with

FAS/FASDAsperger’s DisorderAsperger’s DisorderAttention Deficit Attention Deficit Hyperactivity Disorder Hyperactivity Disorder (ADHD)(ADHD)Autistic DisorderAutistic DisorderBorderline Personality Borderline Personality DisorderDisorderConduct DisorderConduct DisorderAnxiety DisorderAnxiety Disorder

DepressionDepressionLearning DisabilityLearning DisabilityOppositional-Defiant Oppositional-Defiant DisorderDisorderPost Traumatic Stress Post Traumatic Stress Disorder (PTSD)Disorder (PTSD)Receptive-Expressive Receptive-Expressive Language DisorderLanguage Disorder

Brain Regions Affected by Alcohol

Structural Changes in the Brain

In the top picture the brain of a In the top picture the brain of a non-surviving child with FAS is non-surviving child with FAS is shown next to that a non-shown next to that a non-surviving child’s brain without surviving child’s brain without FAS.FAS.

The extent of malformation in the The extent of malformation in the child’s brain was not compatible child’s brain was not compatible with life.with life.

The same brain is shown below. The same brain is shown below. Note the lack of internal Note the lack of internal structures such as the corpus structures such as the corpus callosum which connects the two callosum which connects the two hemispheres.hemispheres.

Common Brain Abnormalities

Mattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995

1. Child w/o FAS 2. Thin, at rear of brain

3. Corpus callosum missing

9 year old with FAS• Absence of corpus callosum• Coprocephaly

General Intellectual Performance

FSIQ VIQ PIQ40

55

70

85

100

115

Sta

nd

ard

sco

re

IQ scale

NC

PEA

FAS*

**

**

**

Mattson, S.N., 1997.

Neuropsychological Performance

FSIQ Read Spell Arith PPVT BNT ATotal VMI PegsD CCT40

50

60

70

80

90

100

110

120

Measure

CON

PEA

FAS

Mattson, et al., 1998

Executive Functioning deficits

SELF-REGULATION -The ability to stay in control of SELF-REGULATION -The ability to stay in control of emotions; awareness of how other perceive you; use of self-talk emotions; awareness of how other perceive you; use of self-talk strategies to monitor self and behaviorstrategies to monitor self and behavior

SEQUENCING OF BEHAVIOR - Knowing when and how to SEQUENCING OF BEHAVIOR - Knowing when and how to start and activity, keeping track of what to do next, initiating start and activity, keeping track of what to do next, initiating tasks.tasks.

FLEXIBILITY -The ability to shift tasks smoothly, accept FLEXIBILITY -The ability to shift tasks smoothly, accept change, deal with transitions appropriately, absence of rigidity.change, deal with transitions appropriately, absence of rigidity.

RESPONSE INHIBITION - The ability to think before actingRESPONSE INHIBITION - The ability to think before acting

Executive Function Executive Function Deficits (cont)Deficits (cont)

PLANNING -The ability to use mental and action steps to complete PLANNING -The ability to use mental and action steps to complete tasks, to anticipate what is needed to complete tasks, related to tasks, to anticipate what is needed to complete tasks, related to sequencing of behavior.sequencing of behavior.

ORGANIZATION - The ability to keep one’s self and materials ORGANIZATION - The ability to keep one’s self and materials organized, in order, predictable, etc.organized, in order, predictable, etc.

WORKING MEMORY- Holding info in head while performing action WORKING MEMORY- Holding info in head while performing action on it.on it.

ATTENTION - Maintaining and switching attention, distractibility.ATTENTION - Maintaining and switching attention, distractibility.

MOTOR CONTROL -Particularly fine motor.MOTOR CONTROL -Particularly fine motor.

Executive Function and Behavior

BehaviorBehavior Executive FunctionExecutive Function

RageRage Self-regulation, flexibilitySelf-regulation, flexibility

Disorganization, messinessDisorganization, messiness Organization, planning, Organization, planning, sequencingsequencing

Difficulty with transitionsDifficulty with transitions Flexibility, self-regulationFlexibility, self-regulation

Not finishing assigned tasksNot finishing assigned tasks Sequencing, planningSequencing, planning

InefficiencyInefficiency Organization, planningOrganization, planning

Adaptive functionsAdaptive functions AllAll

Moodiness, labilityMoodiness, lability Self-regulationSelf-regulation

INFORMATION PROCESSING DIFFICULTIES

InputInput-recording information-recording information

IntegrationIntegration-interpreting input-interpreting input

MemoryMemory-storing input for later use-storing input for later use

OutputOutput-appropriate use of language and motor skills-appropriate use of language and motor skills

““Of all the substances of abuse Of all the substances of abuse (including cocaine, heroin and (including cocaine, heroin and marijuana), alcohol produces, marijuana), alcohol produces, by far, the most serious by far, the most serious neurobehavioral effects in the neurobehavioral effects in the fetus”fetus”

IOM Report IOM Report to Congress, 1996to Congress, 1996

Problem Domains of Individuals with Prenatal Alcohol

exposureCognition/Intellectual FunctioningCognition/Intellectual Functioning

Activity and AttentionActivity and Attention• HyperactivityHyperactivity• Focusing, encoding, shiftingFocusing, encoding, shifting

Learning and MemoryLearning and Memory• Auditory, spatial, design, and narrative memoryAuditory, spatial, design, and narrative memory• Working memoryWorking memory• Intrusion, perseveration, false-positive errorsIntrusion, perseveration, false-positive errors• Comprehension, math reasoningComprehension, math reasoning

Problem Domains of Problem Domains of Individuals with Individuals with Prenatal Alcohol Prenatal Alcohol exposure (cont)exposure (cont)LanguageLanguage

• Social communicationSocial communication• Word comprehension, naming ability, articulationWord comprehension, naming ability, articulation• Expressive and receptive language skills Expressive and receptive language skills

Motor Abilities Motor Abilities • Fine and gross motor dysfunctionFine and gross motor dysfunction• Delayed motor developmentDelayed motor development• Speed/precision, grip strengthSpeed/precision, grip strength

Processing AbilitiesProcessing Abilities• Spatial memory, processing of visual and auditory informationSpatial memory, processing of visual and auditory information• Difficulties in motor control and functioningDifficulties in motor control and functioning

Problem Domains of Problem Domains of Individuals with Individuals with Prenatal Alcohol Prenatal Alcohol exposure (cont)exposure (cont)Other Neuropsychological Abilities/Executive FunctioningOther Neuropsychological Abilities/Executive Functioning

• Behavioral and emotional regulation-impulsivity, labilityBehavioral and emotional regulation-impulsivity, lability• Planning/organizationPlanning/organization• Abstract thinking/judgmentAbstract thinking/judgment

Sensorimotor IntegrationSensorimotor Integration

Social Skills and Adaptive behaviorSocial Skills and Adaptive behavior

Mental Health IssuesMental Health Issues

Clinical Implications of Implications of Impairments for Impairments for Individuals with Individuals with

FAS/FASDFAS/FASDPoor judgment and decision making, which increases Poor judgment and decision making, which increases susceptibility to being victimizedsusceptibility to being victimized

Attention deficits, which increase distractibility and lack of Attention deficits, which increase distractibility and lack of focusfocus

Arithmetic disability, which leads to difficulty in handling Arithmetic disability, which leads to difficulty in handling moneymoney

Memory impairment, which makes learning from experience Memory impairment, which makes learning from experience difficultdifficult

Difficulty abstracting, which makes it difficult to understand Difficulty abstracting, which makes it difficult to understand the consequences of one’s behaviorthe consequences of one’s behavior

Clinical Implications of Impairments for Individuals with

FAS/FASDDisorientations of time and space, which complicate accurately Disorientations of time and space, which complicate accurately perceiving social cues, missing appointmentsperceiving social cues, missing appointments

Impulsivity and poor self-regulation, which decreases tolerance for Impulsivity and poor self-regulation, which decreases tolerance for frustration, and makes them quick to angerfrustration, and makes them quick to anger

Poor habituation which results in drowning in stimulation, Poor habituation which results in drowning in stimulation, emotional overload, shutting down and behaving irrationallyemotional overload, shutting down and behaving irrationally

Perseveration which leads to doing the same thing over and over Perseveration which leads to doing the same thing over and over againagain

Difficulty with self reflection which leads to not being able to Difficulty with self reflection which leads to not being able to express ones’ needs and not getting helpexpress ones’ needs and not getting help

Secondary Disabilities Resulting from the Primary

Disabilities of adolescents/adults with

FAS/FASD60% have trouble with the law60% have trouble with the law50% will be confined in prison, mental institutions, 50% will be confined in prison, mental institutions, treatment centerstreatment centers35% have alcohol and/or drug problems35% have alcohol and/or drug problems61% have disrupted school experience61% have disrupted school experience49% exhibit inappropriate sexual behavior49% exhibit inappropriate sexual behaviorOther: joblessness, homelessness, inability to Other: joblessness, homelessness, inability to demonstrate effective caretaking and parenting, and demonstrate effective caretaking and parenting, and increase potential for victimization, need for lifelong increase potential for victimization, need for lifelong supervisionsupervision

((Streissguth, 2004)Streissguth, 2004)

Reconceptualizing the Behavior of the Child

with FASIt may be helpful for professionals, family members, and It may be helpful for professionals, family members, and caretakers to reconceptualize how they view the behavior caretakers to reconceptualize how they view the behavior of an individual with FAS/FASDof an individual with FAS/FASD

From seeing: From seeing: To understanding: To understanding:

• Won’t Can’t• Bad Frustrated, defended, challenged• Lazy Tries hard• Lies Fills in• Doesn’t try Exhausted or can’t start• Mean Defensive, hurt, abused• Doesn’t care Can’t show feelings• Refuses to sit still Over stimulated• Fussy, demanding Oversensitive• Resisting Doesn’t “get it”• Trying to get attention Needing contact, support

Common Positive Characteristics of

Individuals with FASD Many individuals with FASD are:Many individuals with FASD are:

Cheerful, friendly and happyCheerful, friendly and happy Caring, kind, loyal, nurturing and compassionateCaring, kind, loyal, nurturing and compassionate Trusting, loving, determined, committed and Trusting, loving, determined, committed and

persistentpersistent Curious, involved, fair and cooperativeCurious, involved, fair and cooperative Energetic, hard working and athleticEnergetic, hard working and athletic Artistic, musical and creatively intelligentArtistic, musical and creatively intelligent Kind with young children and animalsKind with young children and animals..

FAS Developmental FAS Developmental OverviewOverview Infants

Poor sleep-wake cycles/irritabilityPoor sleep-wake cycles/irritability

Failure to thrive (poor weight gain)Failure to thrive (poor weight gain)

Chronic ear infectionsChronic ear infections

Difficulty nursingDifficulty nursing

Developmental delaysDevelopmental delays

Speech delaysSpeech delays

Early Intervention and Special Education servicesEarly Intervention and Special Education services

Toddlers

Delay in potty trainingDelay in potty training

Continued developmental delaysContinued developmental delays

Distracted easilyDistracted easily

Colds, infections, other illnessColds, infections, other illness

Eating (small appetites or sensitivity to food texture)Eating (small appetites or sensitivity to food texture)

Fidgeting (meal time or other structured event)Fidgeting (meal time or other structured event)

Often exhausted/irritable due to poor sleepOften exhausted/irritable due to poor sleep

Danger to self-not grasping cause and effectDanger to self-not grasping cause and effect

Usually high maintenance-24/7Usually high maintenance-24/7

Pre-Schoolers

Delayed speech developmentDelayed speech development

Altered motor skillsAltered motor skills

Attention deficits/Learning deficitsAttention deficits/Learning deficits

Caregiver concerns: manipulative, does not Caregiver concerns: manipulative, does not understand cause and effect, problems with understand cause and effect, problems with judgement and memory judgement and memory

School AgeSchool AgeBedtimeBedtimeMaking and keeping friendsMaking and keeping friendsDifficulties determining body language and Difficulties determining body language and expressionsexpressionsBoundary issuesBoundary issuesAttention problems/ImpulsiveAttention problems/ImpulsiveEasily frustrated/tantrumsEasily frustrated/tantrumsDifficulty understanding cause and effectDifficulty understanding cause and effectCaregiver concerns: emotionally volatile, Caregiver concerns: emotionally volatile, manipulative, unpredictable, increased need for manipulative, unpredictable, increased need for stimulation and excitementstimulation and excitement

AdolescentsStill need limits and protection due to deficits in reasoning, judgment and Still need limits and protection due to deficits in reasoning, judgment and memorymemoryHigh risk of being drawn into anti social behavior eg stealing, lying, High risk of being drawn into anti social behavior eg stealing, lying, drugs-”thrill seekers”drugs-”thrill seekers”Unable to distinguish between friends/enemies; impaired judgment for decisionsUnable to distinguish between friends/enemies; impaired judgment for decisionsStruggle to accept their own disability while trying to prove ability to be Struggle to accept their own disability while trying to prove ability to be independentindependentOften obsessed by primal impulses-sex, firesettingOften obsessed by primal impulses-sex, firesettingLacks remorseLacks remorseNegligent of normal hygieneNegligent of normal hygieneExtremely vulnerable to suggestions in movies, TVExtremely vulnerable to suggestions in movies, TVHigh risk for school dropoutHigh risk for school dropoutUnable/unwilling to take responsibility for actionsUnable/unwilling to take responsibility for actions

AdultsMoral chameleonsMoral chameleonsOften exhausted and irritable – poor sleepOften exhausted and irritable – poor sleepVulnerable to anti-social behavior – find structure and Vulnerable to anti-social behavior – find structure and supervision in criminal justice systemsupervision in criminal justice systemUnlikely to follow safety rules – fire hazards, vehicles, Unlikely to follow safety rules – fire hazards, vehicles, basic life needsbasic life needsLacks ability to manage moneyLacks ability to manage moneyIncapable of taking daily medsIncapable of taking daily medsVulnerable to panic, depression, suicide, psychosisVulnerable to panic, depression, suicide, psychosisNeed sheltered environmentNeed sheltered environment

The NJ FASD Regional Diagnostic Centers

Following the recommendations of the Governor’s Task Force on FASDs, 6 Regional FASD Diagnostic Centers were created in 2002.

These centers work together to meet the mandate from the state, and the recommendations put forth by the Governor’s Task Force.

Comprehensive Assessment Comprehensive Assessment and Management of and Management of

Individuals with FAS/FASDIndividuals with FAS/FASDTeam approachTeam approach

Multi-discipline assessmentMulti-discipline assessmentPsychosocial historyPhysicianDisciplines (Psychologist, Speech, OT/PT, LDTC, Psychiatrist)Parents/caregivers, TeachersSocial service agencies (DDD, SS, Child protection, drug treatment centers)

Case managementCase managementDiagnosisEarly intervention and trackingStable home environmentMedicationCase manager/mentor in school/home/communitiesSupport services-family community, educational, vocationalSupervised housing/residential facilitySpecial education and vocational rehabilitation

Best PracticeOne prevention model contains seven basic components, form the One prevention model contains seven basic components, form the acronym SCREAMSacronym SCREAMSSStructure: a regular routine with simple rules and concrete, one step tructure: a regular routine with simple rules and concrete, one step instructioninstructionCCues: verbal, visual, or symbolic reminders can counter the memory ues: verbal, visual, or symbolic reminders can counter the memory deficitsdeficitsRRole models: family, friends, TV shows, movies that show healthy ole models: family, friends, TV shows, movies that show healthy behavior and life stylesbehavior and life stylesEEnvironment: minimized chaos, low sensory stimulation, modified to nvironment: minimized chaos, low sensory stimulation, modified to meet individual needs.meet individual needs.AAttitude: understanding that behavior problems are primarily due to ttitude: understanding that behavior problems are primarily due to brain dysfunctionbrain dysfunctionMMedications: most often the right combination of meds can increase edications: most often the right combination of meds can increase control over behaviorcontrol over behaviorSSupervision: 24/7 monitoring may be needed for life due to poor upervision: 24/7 monitoring may be needed for life due to poor judgment, impulse control.judgment, impulse control.

Guiding principles Think:Think: “Stretched Toddler”. “Stretched Toddler”.

Remember:Remember: “Individuals with FASD “Individuals with FASD will always need an will always need an external brain.”external brain.”

Acknowledge:Acknowledge: Interventions must be Interventions must be useful to, and usable by useful to, and usable by

the individual in order to the individual in order to be an intervention.be an intervention.

Foster:Foster: Inter-dependence.Inter-dependence.

Reflect:Reflect: Respect.Respect.

Promote:Promote: Self-worth.Self-worth.

Guiding principles Support:Support: Self-esteem.Self-esteem.

Understand:Understand: That FASD is not “Chicken Pox.” That FASD is not “Chicken Pox.” You can’t catch it and it never goes You can’t catch it and it never goes away.away.

Shift:Shift: From a “non-compliance” From a “non-compliance” model to a “non-model to a “non-competence” model.competence” model.

Accept: Accept: Individuals with FASD do the Individuals with FASD do the best they can with what they’ve best they can with what they’ve got at that time.got at that time.

Believe:Believe: You can make a difference.You can make a difference.

Be good to me...                Stay alcohol free!

                                                               A few drinks canLast forever  No safe time. No safe amount. No

safe alcohol. Period…. -NIAAA/NOFAS