FASD

1. FASD “They may forget what you said, but they will never forget how you made them feel.” - Carol Buchner Ali Pravda, Chelsea Baynham, Shanna Vaughn, Victoria Glass

2. Outline • What is FAS vs. FASD? • Primary vs. Secondary • Understanding FASD • Identifying FASD in the classroom • Tools for success

3. Drinking During Pregnancy • Drinking at any time during pregnancy (and breast feeding) may affect development. • Stopping drinking at any time during pregnancy improves the outcomes for both parent/child • Alcohol kills brain cells • If large amounts of alcohol are consumed, and enough brain cells are damaged, the brain will actually be smaller. • some people may not show a difference in brain/ head circumference but may show lesions and difference in structure and function of the brain. • Sometimes these lesions are not observable.

4. Effects of Alcohol on the Brain • The brain is more sensitive to the effects of prenatal exposure to alcohol and other drugs. • The Brain is growing and developing throughout gestation and is affected differently and at different times. • Timing of exposure, peak drug/alcohol levels, genetics, nutrition, stress, age of parent etc. all contribute to a wide range of effects. • No two people with FASD are the same.

5. What is FAS? If alcohol is not consumed in the first trimester, when the fetus is forming the child will not have full FAS. For a full diagnosis of FAS there must be a medical diagnosis and meet specific criteria. 1) Small physical size including head circumference , body weight, and length 2) Evidence of central nervous system involvement (brain differences affecting learning, activity levels, sensitivity, etc.) 3) Facial Characteristics (small eye openings, thin upper lip, small jaw, etc.)

6. What is FASD? • Fetal Alcohol Spectrum Disorder has a range of effects. • Someone with FASD was exposed to alcohol while in the womb, and will have the disorder and symptoms for life. • FASD is a physical disability: People w/ FASD have differences in their brain • Primary disabilities are: cognitive, sensory, physical, and behavioral.

7. What is FASD? • It is the leading cause of developmental disability in North America • Health Canada estimates that ~ 1 in 100 babies will be born with FASD • People without full FAS are more difficult to diagnois / identify as they have few or no physical symptoms.

8. Diagnosis • It is known as an “invisible disability”. • Diagnosis is complex. Facial anomalies is a small percent of cases, effected by drinking early on. • Therefore people up to adulthood can be undiagnosed or misdiagnosed.

9. The disorder can co-occur or be misdiagnosed with other mental illnesses: • Attention Deficit/Hyperactivity Disorder • Psychotic Disorders • Autism Spectrum Disorder • Asperger’s Syndrome • Bipolar Disorder • Schizophrenia • Conduct Disorder • Traumatic Brain Disorder • Learning Disabilities • Tourett’s Syndrome • Disruptive Behavior Disorder

10. Central Nervous System Impairment • Structural • Physical / observable damage to the brain • Neurologic • Epilepsy, clumsiness, poor hand-eye coordination, neurosensory hearing loss • Functional • Range of functional disabilities

11. Primary Disability: 1. Cognitive • Slower cognitive pace • Slower auditory processing • Impaired executive functioning (e.g. decision making) • Problems generalizing • Poor memory • Poor judgment • Confabulation and untruths (result from memory problems) • Speech and language problems

12. Common Impairments Cognitively • Lower IQ – especially with areas of language comprehension and math • Average IQ for full FAS is 70 and ranges anywhere from 20-130 • A person with FASD may have an “average” IQ and still have significant differences in brain functioning. • Conceptual and abstract thinking (e.g. poetry) • Cause and Effect • Generalization • Time and money understanding • Memory

13. Primary Disability: 2. Behavioral • Difficulty reading social cues • Impulsive actions • Immaturity • Vulnerability to peer pressure • Lack of inhibitions – overly friendly • Difficulty regulating emotions • Poor understanding of boundaries and personal space • Difficulty with transitions (perseveration)

14. Primary Disability: 3. Physical • Delayed motor development • Heart defects • Kidney underdeveloped or misplaced • Teeth – poorly aligne, faulty enamel • Cleft palate • Hearing loss • Vision problems • Health problems • Low birth weight/height • Facial features

15. Primary Disability: 4. Sensory • Hypo-sensitive vs. Hypersensitive • Sensory seeking or avoiding • Become overwhelmed and over-stimulated • Very sensitive to touch, movement, light, sound, or smell, therefore difficulty concentration when any of these are in excess. • Pain – high or low tolerance • Do not recognize hunger • Lack of empathy • Overload from sensory input – shut down

16. Secondary Disabilities These occur if there is no support or services for these individuals (resulting in continued failure): • Substance abuse • Relationship difficulties • Employment challenges • Homelessness • Trouble with the law (either offender or victim) • Money management issues • Low self-esteem • Anger management problems

17. Challenges in Life • Challenges are caused by their primary disabilities (cognitive, behavioral, physical and sensory). • Problems with: • Behavior • Decision Making • Problem Solving • Memory • Social Conditioning • Time Management

18. Possible Chronological-age vs. Developmental-age • Age 13 Expectations: • Act responsibly • Organize themselves, plan ahead, follow through • Meet deadlines after being told once • Initiate, follow through • Have appropriate social boundaries • Understand body space • Establish and maintain friendships • Age 13 (going on age 8) Developmental: • Need reminding • Need visual cues, modeling • Comply with simple expectations • Need prompting • Kinesthetic, tactile, lots of touching • In your space • Forming early friendships

19. Possible Chronological-age vs. Developmental-age • Age 18 Expectations: • On the verge of independence • Maintain a job and graduate from school • Have a plan for their lives • Form relationships, safe sexual behavior • Budget their money • Organize, accomplish tasks at home, school, job • Age 18 (going on age 10) Developmentally: • Need structure and guidance • Limited choices of activities • Live in the “now”, little projection into the future • Easily led, impulsive and sometimes inapproptiate sexual behavior • Need an allowance • Need to be organized by adults, limited self-management

20. Identifying vs Labeling • Identifying is different from labeling, labels are more liberally applied. • One concern about labeling a child with FASD is unlike other conditions who’s cause is unknown…FASD immediately implicates the parent(s)

21. Mental Shifts: Understanding • The “brain – behavior link” has been affected • i.e. alcohol affected the structure and neurochemistry of the brain • The person isn’t lazy, they are tired of failing when they try hard. • The person doesn’t lie, but fills in the blanks • The person isn’t fussy, but oversensitive • The person isn’t trying to get attention but needs contact and support. • The person should not be seen as acting inappropriately, but is instead displaying behaviors of a younger child.

22. 10 Things to Think About in the Classroom: • What is the lighting like? • What is the noise level? Can I introduce calming music or headphones? • Are there smells? Can I add smells? • Visual Distractions? Anything on the walls? • Are students seeking sensual stimulation? • Are students becoming overwhelmed? • What are transition times like? • Do I need to change the seating arrangment? • How do I prepare students for a change in schedule? • Are my students dressed appropriately for the weather?

23. 1st Person Experiences People with FASD: • “It’s like the wiring is scrambled, sometimes things just don’t connect.” • “Inside my head it’s like there are all these sheets of paper. Today they’re all blank.” • “It’s like there’s a window in my brain and sometimes the window is open and sometimes it’s closed.”

24. Students with FASD -Students with FASD have a wide range of intellectual levels and disabilities *This reflects the differing degrees of brain damage -The patterns of FASD are unique to the individual. -Some students with FASD may learn well in school but may have behavioral or social issues in other areas of life.

25. Students with FASD have Characteristics such as: • Difficulty listening, paying attention and working with others. • Appearing to know something one day, forgetting it the next and then knowing it again after several days. • Being highly verbal but often misinterpreting what others are saying. • Difficultly learning concepts, organizing, sequencing, problem solving and developing age-appropriate social skills. • Difficulty making and keeping friends because of their behavioral difficulties.

26. Students with FASD • Students with FASD do not outgrow the effects over time. • As they get older they may also experience difficulty evaluating situations and using past experiences to cope with current problems. • They may need different degrees of protection, supervision, and structure throughout their lives, especially as teenagers and young adults.

27. Difficulties with Change • Give students transitions ahead of time • Prepare students for change by explaining what is expected of them, give them time to prepare • If possible, prepare them for a sub – keeping consistent. • Distract them if in a power struggle (e.g. using humor) • Keep the rules simple and speak to other teachers to have consistent rules as well

28. Difficulties with Ownership • Ownership issues arise from their behavioral disability (such as stealing or giving items away) • Use words the student can understand • Have all the student’s things marked with his or her names • Store valuables out of sight • If student steals, have them return the item with an apology

29. Classroom Strategies: Self-Esteem • Notice what the student has done well and give reinforcement • Use rewards and positive consequences • Celebrate successes • Find Strengths – Build on them

30. Classroom Strategies: Decision Making and Abstract Thinking • Give only two acceptable choices • Make rules clear • Allow the child time to make decisions • Use pictures or charts to help explain • Do things the same way, use the same words every time

31. Classroom Strategies: Memory Problems • Keep daily routines • Have schedules posted • Break tasks down • Use repetition • Help the student with a day planner • Give only one instruction at a time • Exercise patience (e.g. re-teaching)

32. Classroom Strategies:Slow Cognitive Pace • Slow down your speech • Don’t rely on “talk” to teach • Use visual supports • Give students down time if getting “overloaded” • Use transitions to prevent overload • Increase your wait time with questions • Ask only one question at a time

33. Classroom Strategies:Filling in the ‘gaps’ • Break things into smaller steps • Use consistent language (figurative expressions may be taken literally) • Have students repeat instructions (they may have heard something else)

34. Classroom Strategies: Be Clear – Be Direct – Redirect • Make Directions concrete and literal • E.g. “Please walk on the right side of the hallways and leave room between you and other people”; rather than “Watch how you move in the hallways”. • Be direct with students about what to do, rather than tell them what not to do. Phrase questions in positive ways. • E.g. “Walk slowly in the hall”; rather than “Don’t run in the hallways”. • Redirect students who are misbehaving. • If a student is starting to roughhouse with another student in line, simply ask one student to move (“please come here and carry this book for me”).

35. Classroom Strategies: • When misbehavior occurs, the focus should be on identifying what the student needs in order to be successful in this situation. • Many students with FASD don’t always have logical reasons for why they behave the way they do. Because they often have difficulty connecting cause and effect, many conventional behavior management strategies based on consequences (eg. Punishments, rewards or combination of both) have limited effectiveness with these students. • Support Positive Behavior

36. Teach about Drugs and Alcohol • Talk about the dangers early • They are easily influenced and vulnerable to peer pressure • Encourage the child to participate in healthy pastimes and activities.

37. Teach about Sexuality • Prone to sexual exploitation, both as a victim and an offender • Teach about boundaries • Teach about the dangers of the internet and chat rooms • Use clear and simple words – be concrete • Address issues as they arise

38. Necessary Activities • Make a “My Strengths Inventory” • Make a “Interest Inventory” • Give child access to “Feeling Better” worksheet • Help fill out a “How I Learn Inventory” • Make a “Circle of Friends” and “Circle of Support” diagram • Have a “My School Day Report”

39. Strengths Inventory Students name: Date: • 4 things you did this year that you are proud of: B. 4 everyday things you do well: C. 2 things you could teach someone else: D. 10 positive words to describe yourself: E. 2 things that really matter to you: F. 2 things you can do for yourself that always make you feel good G. 2 people who you can count on for help and support:

40. Strengths to consider • Affectionate • Caring • Curious • High energy • Musical • Sense of wonder • Artistic • Concrete thinker • Enthusiastic • Kind • Outgoing • Spontaneous • Athletic • Creative • Friendly • Learn by doing • Sense of humour • Trusting

41. Individual Student Support Plan • Seating: front; back; near teacher; away from distractions; allow standing or kneeling; provide alternate workspace • Instructional Presentation: • adapt pace of lesson; • highlight key points of info; • provide regular review time in class; • provide examples completed by other students; • colour code print material; • break info into smaller steps; photocopy notes

42. Individual Student Support Plan C. Assignment Completion: • allow extra time; • cover parts of worksheet; • increase white space for answers; • reduce amount of info/questions per page; • ensure student records info in agenda; • provide weekly lists of homework/reading assignments; • allow use of calculator; • provide checklist of steps to complete activity; • use computer to complete assignment

43. Individual Student Support Plan D. Attention Support: • Reduce materials on desk • Provide checklist for organizational tasks • Provide buddy to clarify missed information • Use nonverbal or verbal sign to cue student E. Behavior Support: • Provide buddy suport to model appropriate behaviour • Use agenda to communicate with other teachers • Provide positive reinforcement • Create opportunities for breaks (e.g. for water, to the library)

44. Individual Student Support Plan F. Reading Support • Allow extra time • Buddy Reading • Use of text-to-speech software G. Writing Support • Use of word processor (inc. spellcheck) • Allowing point form to replace paragraphs • Providing copies of notes and teaching students to identify and highlight main ideas • Providing graphic organizers for planning • Shared reading with trained peers or volunteers

45. Individual Student Support Plan H. Assessment and Evaluation • Smaller chunks of info or simpler concepts • Use individual criteria to evaluate tasks • Use notes or textbook during tests • Allow extra time on tests • Use of word processor • Clarify directions

46. Teacher as AdvocateandTeam Approach • Make other teachers aware of their needs • Regular contact with the home • Involve students in school activities (reminding of signups, introducing to coaches, etc.) • Watch for issues (e.g. missing their favorite classes)

47. Take Action in School to Student and Beyond • Help school staff build an understanding of FASD • Identify student strengths and interests • Align strategies with student needs • Build rapport with school staff • Keep informed about current research and best educational practices • Support positive behavior • Work with staff to make school a safe place • Help build a circle of peer support • Help build a circle of adult support • Plan for transitions • Support learning at home • Advocate for increased understanding and support for students with FASD

48. Think About: • “The curriculum is so much necessary material, but warmth is the vital element for the growing plant and for the soul of the child.” – Carl Jung • Student throwing his homework away because he forgot how to do it. He said it’s better to appear bad than stupid.

49. Support • Mentorship • Repeat, Repeat, Repeat • Structure, Routine, and Consistency

50. Support and Contact • FASD Support Network of Saskatchewan Inc. • All services are free • www.skfasnetwork.ca • 1-866-673-3276 • Canadian Mental Health Association (CMHA) • Regina: (306) 525-5601, Saskatoon: (306) 384-9333 • 1-800-461-5483 • contactus@cmhask.com; info@cmhasaskatoon.ca • Saskatchewan Prevention Institute • www.preventioninstitute.sk.ca