When Good Parenting Doesn’t Work

1. When Good Parenting Doesn’t Work Part II Interventions

2. What a Provider Can Do For an Infant • Hold baby frequently, pressure on stomach • Wrap baby in soft blanket, arms bent • Limit stimulation - use soft lights, soft sounds and no strong perfume • Keep actions soothing - avoid bouncing, rapid patting • Feed small amounts frequently, upright position. Offer pacifier.

3. What a Provider Can Do For an Infant • Keep a regular routine • Rock baby vertically • Be careful of clothing that may be painful, such as plastic on diapers • Consult regularly with a knowledgeable doctor • The adult must remain calm

4. What a Parent (Provider) Can Do - Toddler to Teen Determine whether each behavior is primary (because of brain differences) or secondary (learned) Distinguish Between CAN’T and WON’T

5. Guidelines • Observe behaviors objectively • Time of day • Is the child hungry or tired • People present (how many and who?) • Recent changes for the child • Trigger for the behavior • Results of the behavior for the child • Look for patterns and what they say about the child • Observe positive behaviors – not just negative ones

6. Guidelines • Assess the child: • Strengths • Developmental age • Behavior when hungry or tired • Speed of processing • Ability to abstract • Ability to follow directions • Decision-making ability

7. Guidelines • Ask “What if” the behaviors reflect neurological differences? • Err on the side of assuming the child doesn’t understand or couldn’t do what’s asked.

8. Guidelines • Look at the “fit” between the child and the environment. • Sensitivity to stimuli • Cues to frustration • Memory problems • Changes of people or schedule • What do the behaviors say? • Fatigue, Fear, Failure, Frustration? • Include the child in the discussion.

9. What a Parent (Provider) Can Do - Toddler to Teen If the child CAN’T do what’s asked, Modify the Environment Work with what he/she CAN DO Modify Your Expectations

10. Definition of Environment • Physical Space • Sights, sounds, smells, textures, stimulation, changes • Culture • Attitudes • Values and Beliefs • Bias and Prejudice • Nonverbal Language • Adult Expectations for the Child

11. Environmental Modifications: Learning Basic Rules/Routines • Consider child’s understanding of cause & effect when developing behavior plans • Provide immediate & frequent feedback for positive & negative behaviors • Remember all the rewards in the world will be unsuccessful in motivating a child to do something that is beyond his/her capabilities.

12. What a Parent (Provider) Can Do - Toddler to Teen • Get a Diagnosis • Sewell Center - 303-399-1800 • Local D&E Clinics Develop a Local Diagnostic Team • Pediatrician • Psychologist • Occupational/Physical Therapist • Speech Therapist • Family Advocate

13. What a Parent (Provider) Can Do - Toddler to Teen • Start with Child Find or School Testing • Get OT, Audiology, etc. Testing • Teens – Get a Neuropsychological • Fight for Special Education • Educate the Caseworker

14. What a Parent (Provider) Can Do - Toddler to Teen • Help child understand his condition • Accept the child’s condition as a medical disability • Include the child in developing solutions to problem behaviors • Identify strengths, skill and interests • Create chances for success; limit failure

15. What a Parent (Provider) Can Do - Toddler to Teen • Prevention is more effective than any response! • Learn to identify early warning signs & intervene early by reducing stressors in the child’s environment

16. Interventions Be Creative

17. Interventions • Understand how the child processes • Accept the child’s condition as a medical disability • Identify the developmental age • Identify strengths, skill and interests • Create chances for success; limit failure • Provide structure rather than control

18. Interventions Treat the child as you would a child of the same age as his/her development

19. InterventionsDecision-Making • Give safe, simple choices • Avoid open-ended decisions • Create structure - consistent expectations • Talk about cause and effect in ordinary situations

20. InterventionsMemory • Use lists and charts to remind child • Be prepared to repeat the same thing over and over • Understand that a child may learn something one day, forget it the next, and remember it another time • Give only single directions

21. InterventionsConcrete Thinking • Be as concrete and literal as you can • Say exactly what you mean • Avoid teasing or jokes • Avoid abstract expressions like “cut it out”, “cool it” • Tell the child specifically what you want

22. TAKE “DON’T”OUT OF YOURVOCABULARY

23. InterventionsDisorganized Mind • Use as much structure and consistency as you can • Use the same words for key phrases and oral directions • Coordinate words and phrases with school, parents, caretakers • Be sure expectations are ALWAYS the same

24. InterventionsDisorganized Mind • Communicate with the school - prepare the child if something is going to change (substitute teacher, assembly) • Assess the schedule at school • Passing between classes. • Be specific – say exactly what you want

25. InterventionsPerseveration • If the child cries or gets angry when working, consider doing another activity before trying this again • Provide enough time to finish activities • Create transitions between activities

26. InterventionsAbility Differences • Teach using all of the senses: • Tell her • Show her • Let her feel it • Understand that the child may be able to express more than he understands • Another child may understand but can’t communicate what’s learned

27. InteventionsSlow Thinking or Hearing • Give enough time to respond • Understand that mis-understanding may be because of guessing • Check this issue if you think the child is “lying”

28. InterventionsSlow cognitive Development • Give enrichment without overstimulation • Work specifically on social skills • SUPERVISE carefully

29. Other Interventions • Establish relationships for the child in each environment in which he/she functions • Limit TV times - be selective • Help develop skills for expression of feelings • Understand that a lesson must be taught over for each new situation

30. Other Interventions • Practice desired positive behavior with Role Play • Create an “external brain” • Have a regular schedule set • Have a support person even for adults • Create clear rules and reminders • Have activities that support the schedule

31. Where to Start Look at Developmental Age

32. Transitions • Think “Younger”, Longer, and In Smaller Steps • Provide Enough Time • Prepare for Transitions • Make them Concrete • Check if apparent and actual abilities are the same • Develop supports

33. Educational Support • Establish effective partnerships with school, family, & all service providers, especially mental health • Develop academic & behavioral plans that take into account brain differences • Support the development of creative solutions to school environment issues

34. Remember:The Child’s Brain Is Different You Cannot Love, Parent, or Behavior Manage away Brain Differences

35. Prognosis With Identification and Care • Can learn to understand own disabilities • Often gain a degree of adult maturity by 25-30 • Can often live independently and successfully

36. YOUTH WITH FASDs in the JUVENILE JUSTICE SYSTEM

37. Youth withDisabilities in the Juvenile Justice System • A disproportionate number of youth in the juvenile justice system are identified as having disabilities • Still more are likely to have unidentified or mis-identified disabilities • High risk of school problems – many need Special Education or at least classroom compensations

38. Youth with FASD are More Likely to Be Arrested • Lack avoidance strategies • Scapegoats – Will do “favors” for other kids – or take the rap if a group is caught • No ability to predict consequences • No “stranger danger” • Defiant and uncooperative

39. Police Questioning • High desire to please people • No ability to distinguish friends and acquaintances • Tell you what you want to hear • May tell conflicting stories that are viewed as lying, not memory gaps • Don’t understand roles of various professionals • May tell different story on the stand

40. Competency and FASD • Individuals with an FASD may “sound” or “look” more competent than they are. • They may function at a level much younger than their chronological age. • They may tell you what they think you want to hear. They may or may not know what’s real. • They need SUPERVISION

41. Sentencing and FASD • Incarceration may cause more damage than help • Youth may not understand why incarcerated – especially for long times • Longer probation supervision may be valuable • Look at what the crimes are – avoid commitment for multiple probation violations of lack of follow-through • Create specific sanctions for specific crimes • Write, simplify, and repeat terms of probation

42. Probation Modifications • Often forget appointments or court • Will show up if reminded • Violate curfew • Alarm or cell phone • Don’t follow the terms of probation • May not understand • Put in writing – Make it SIMPLE • Prompt the adults in their lives to help • Get an advocate to help • May show “attitude” because of impulsivity • Have school problems

43. Examples of Modifications • Avoid grabbing the youth whenever possible • Tell the youth what’s happening – don’t assume that he understands • If the youth acts confused when you think an issue is clear, consider that he might actually be confused

44. Understanding the Behavior • Behavior can be caused by factors such as: Attention seeking Escape or avoidance Lack of understanding Anxiety Stress, fear, confusion Overwhelming environment “Bad attitude” Peer pressure

45. Anticipating Problems • Determine external or environmental stimulants. • Use avoidance techniques. • Adjust environment. • Keep things simple. • Use an “external brain.”

46. Few in number Simple Have staff commitment Use the five senses Constructing Rules That Work • Positive terms • Clear and concise • Written down • Explained • Repeated • Based on input from staff or youth

47. Effective Techniques • Consistent expectations • Calm, structured setting • Teaching of desired behavior • Repetition • “External Brain” • Careful supervision • Positive reinforcement • Clear schedules • Consistent limits Source: Deb Evensen

48. Colorado Resources NOFAS Colorado, www.NOFASColorado.org April Montgomery 303-692-2620 17th Judicial District FASD Initiative and North metro Parent Support Group, 2nd Friday 6:00 – 8:00 PM. Eileen Bisgard – 303-654-3246 Fetal Alcohol Prevention & Outreach Project – Pamela Gillen, RN, ND 303-724-0327

49. Seventeenth Judicial District FASD Initiative (Adams Co) Screen all children who come before the court Delinquents, Dependent and Neglected age 0-5 and by court order Probation officers screen PSI and Probation youth Obtain diagnoses for those who screen positive Work with parents, schools, providers to intervene appropriately with the diagnosed children Work with the Parent Support Group

50. Adams County FASD Initiative Eileen.bisgard@judicial.state.co.us Sarah.mclenon@judicial.state.co.us Gina.abdella@judicial.state.co.us nofascolorado.org/projects