Foetal Alcohol Spectrum Disorders Implications for Education

1. Foetal Alcohol Spectrum DisordersImplications for Education

2. Terminology Foetal Alcohol Spectrum Disorders (FASD) has been adopted as an umbrella term that encompasses all of the following terms: • Foetal Alcohol Syndrome (FAS) • Partial Foetal Alcohol Syndrome (PFAS) • Foetal Alcohol Effects (FAE) • Alcohol Related Neurodevelopmental Disorder (ARND) • Alcohol Related Birth Defect (ARBD)

3. Overview • Around 75% of school aged children who have a Foetal Alcohol Spectrum Disorder (FASD) do not have an intellectual disability but will have specific neurological damage that will make learning and managing their behaviour at school challenging. • It is the specific brain damage that has considerable impact on their success at school and in adulthood. • Children with FASD have complex learning difficulties, behavioural challenges and difficulties understanding and expressing language. (Yukon Department of Education, 2006)

4. Behaviours / Characteristics Primary disabilities associated with FASD may include: • Neurological impairment: the I.Q. May vary from well below average to above average. • Information processing deficit: this results in gaps and inconsistencies in understanding, sequencing and auditory processing of information. • Memory and attention deficit: this results in inconsistent or faulty memory and limited attention span. • ADHD Behaviours: impulsivity, distractibility, disorganization. • Difficulty with abstractions such as maths, money management, time concepts.

5. Behaviours / Characteristics (contd) • Inability to predict outcomes or understand consequences. • Emotional regulation: limited development of appropriate social skills and understanding. • Sensitivity to Sensory Input • Delay or dysfunction of language skills: limited vocabulary and comprehension, problems with clarity of speech or speech impairment. • Other deficits/delayed development: may include late walking, late talking, problems with balance, coordination and fine motor skills.

6. Behaviours / Characteristics (contd) • Secondary Disabilities associated with FASD – emotional and/or societal problems related to the difficulty managing typical expectations • Mental health problems (depression, self injury) • Repeated school failures • Trouble with the law • Inappropriate sexual behaviour • Drug and alcohol problems

7. Behaviours Considered Normal Some Behaviours That May be Considered Normal for the Child with FASD: • Push or shove other children without provocation • Flit from one activity to another • Emotional outbursts for no apparent reason • Obsessive and compulsive about certain behaviours Aggressive or unusually friendly towards others • Unreasonable fears yet have no sense of real danger • Non-compliance – not learning from mistakes

8. Areas of Strength Children with FASD frequently demonstrate skills such as: • Highly verbal • Highly developed splinter skills • Artistic, musical, mechanical • Athletic • Determined, Persistent

9. Developmental Difference Traditional Learning Based Theory Required the Brain to: • Understand and process information quickly • Understand ideas and concepts • Make links and form associations • Interpret, store and remember information • Generalize – take what is learnt in one situation and apply it in another

10. Developmental Difference

11. Developmental Difference

12. Viewing Behaviours Differently

13. Viewing Behaviours Differently (contd)

14. Viewing Behaviours Differently (contd)

15. Assessment – Overlapping Behavioural Characteristics & Related Mental Health Diagnoses in Children

16. Assessment – Overlapping Behavioural Characteristics & Related Mental Health Diagnoses in Children (contd)

17. Psychometric Assessments INTELLECTUAL/COGNITIVE WISC-IV STANFORD BINET V • Used to obtain a comprehensive assessment of general cognitive functioning. • Used as part of an assessment to identify intellectual giftedness, intellectual disability, and cognitive strengths and weaknesses. • Results can provide information to assist treatment planning and placement decisions in clinical and educational settings. • Can provide clinical information for neuropsychological evaluation and research purposes.

18. Psychometric Assessments (contd) • NAGLIERI NONVERBAL ABILITY TEST • Provides a brief nonverbal measure of general ability. • Designed to assess a wide range of examinees including those from different cultural and linguistic groups, as well as those with motor or communication difficulties • Wechsler Non Verbal Scale of Ability • Developed to assess general cognitive ability and eliminating or minimizing verbal requirements • A useful instrument for examinees who are diverse in terms of linguistic, cultural, educational and socioeconomic backgrounds, as well as those who have language disabilities and/or hearing impaired.

19. Neuropsychological • Bender Gestalt II • A maturational test of visual-motor integration • Provides information about fine motor development and perceptual discrimination ability. • Inadequate visual-motor performance can result from misperception (faulty interpretation of input information); execution difficulties (faulty fine-motor response output); integration or central processing difficulties (faulty memory storage or retrieval systems). • Specific deviations may be indicative of organicityand/or emotional problems.

20. Neuropsychological (contd) • NEPSY II -From a neuropsychological perspective, the diagnostic approach of the NEPSY originated in the Lurian tradition of assessment of adults with brain injury. - This supposes that cognitive functions, such as attention and executive functions, language, movement, visuospatial abilities, and learning and memory capacities. They are composed of flexible and interactive subcomponents that are mediated by equally flexible, interactive neural networks. - It is therefore important to identify and assess both basic and complex subcomponents that contribute to performance within and across domains.

21. NEPSY (contd) - The basic diagnostic principle that underlies the Lurian approach is to identify the primary deficits underlying impaired performance in one functional domain that affect performance in other functional domains (secondary deficits).

22. Neuropsychological (contd) • QUICK NEUROLOGICAL SCREENING TEST • Designed to detect soft neurological signs often associated with learning disabilities. • Subtest tasks are common to standard paediatric neurological and neuropsychological batteries and include assessment of balance, visual-motor integration, fine and gross motor control, sound discrimination and other developmental tasks.

23. Social / Emotional, Behaviour • Conners III • Focused assessment of Attention Deficit /Hyperactivity Disorder and its most common co-morbid problems and disorders (Anxiety, Depression, CD, ODD). • Multi-informant: parent, teacher and self-report. • Linked to the DSM-IV-TR

24. Social / Emotional, Behaviour (contd) • ASEBA (Achenbach System of Empirically Based Assessment) • Multi-informant (parent, teacher and self-report) • Assesses competencies, adaptive functioning and behavioural/emotional problems • Problem scales are reported in the normal, borderline or clinical range and are linked to DSM - IV –TR • Research is suggesting that responses to individual items on the CBCL may be used for differential diagnosis of FASD and ADHD

25. Social / Emotional, Behaviour (contd)

26. Interventions • WHAT MAKES A DIFFERENCE TO A CHILD WITH FASD TO SUCCEED AT SCHOOL? • The absolute need to establish a positive relationship between teacher and student. • Viewing the child and their learning styles and behaviours as a result of specific brain damage. They then view what they see at school within a context of a brain based disability and this significantly alters how they support the student. • Significant levels of structure and routine in the student’s daily life and adaptation of the sensory environment.

27. 12 Essential Elements for Dealing with Students Affected by FASD • MEETING THE CHALLENGE. Believe in being able to promote success in students with FASD. 2. FAMILIES AND FASD. Understand the strong emotions faced by families living with FASD. 3. TRYING A DIFFERENT APPROACH. When the child with FASD repeatedly makes the same mistake, they need a different approach. 4. ESTABLISHING STRUCTURE Put structures in place for success and teach habit patterns as the pathway to understanding.

28. (Contd) 5. OBSERVING BEHAVIOUR S.O.A.P.: when an academic or behaviour support is not working with a student with FASD – Stop action. Observe. Assess. Plan. 6. INTERPRETING BEHAVIOUR Consider misbehaviours as coming from lack of understanding rather than non-compliance. 7. PHYSICAL ENVIRONMENT Understand how sensory input and sensory processing affect a student’s ability to succeed in the school environment. 8. USING CONCRETE LANGUAGE Talk to students with FASD so they understand.

29. (Contd) 9. FASD AND MEMORY The role that memory plays in being able to sustain a consistent level of performance. 10. ACADEMIC AND SOCIAL SKILLS A brain damaged by alcohol cannot process information in atypical manner. This causes life-long difficulties learning academic and social skills. 11. TRANSITIONS Transition planning should be planned well in advance and requires ongoing teaching of daily living skills. 12. MEASURING SUCCESS Recognize and applaud accomplishments.

30. Strategies SOCIAL SKILLS • Formal, didactic social skills training, including direct modelling and role playing. • Rehearsing and practice how to manage various social situations. • Teaching functional life skills. • Teaching and practising self-advocacy skills. • A ‘buddy system’ can be helpful. • Teaching tolerance and acceptance with other class members.

31. Academic Skills • Explicit, didactic teaching of strategies to assist the child gain proficiency in ‘executive function’ areas such as organization and study skills • Re-evaluate and modify expectations and goals • Modify instructions • Identify and understand needs, strengths, skills and interests • Recognize processing deficits • Understand that Fair does not necessarily mean Same • Identify the range of behaviours that may reflect attempts to communicate

32. Academic Skills (contd) • Help develop skills for expression of feelings • Provide supervision and structure rather than control • Establish routines and build transition into routine • Maintain continuity between home, school and community AN INDIVIDUAL EDUCATION PLAN IS CRITICAL FOR SUCCESS It is important to build on the student’s strengths, make sure goals are realistic and re-evaluate expectations

33. Behaviour Management • Supervision • Structure • Consistency • A daily stable routine • Repetition • Individualize the behaviour plan • Rules should target specific behaviours • Develop a plan for when the student feels overwhelmed • Provide positive feedback whenever possible. • Look for opportunities to shape desirable behaviours

34. Behaviour Management: What Doesn’t Work! • Negative consequences • Big rewards • Star charts • Escalating consequences • Natural consequences • Smacking • Nagging to stop behaviour • Pressure not to break rules • Abstract rules • Choices • Behaviour modification

35. The DET Perspective WHAT IS REQUIRED: • Earliest possible intervention • Multidisciplinary diagnosis of FASD • Educators to be provided with Professional Learning on educating students with FASD • Access to specialist support services to advise on appropriate adjustments to the students’ educational program to accommodate the specifics of the FASD diagnosis • Availability of support staff to assist with implementation of AEP • Specialist support be provided to families impacted by FASD