National Organization on Fetal Alcohol Syndrome

1. National Organization on Fetal Alcohol Syndrome Erin Frey, MD

2. NOFAS FASD K-12 PREVENTION CURRICULUM LESSON PLANS

3. Fetal Alcohol Spectrum Disorders (FASD)

4. Fetal Alcohol Syndrome • First described in 1973 • Definition • Fetal Alcohol Syndrome (FAS) is the term given to a set of physical, mental and neurobehavioral birth defects caused by maternal alcohol consumption during pregnancy

5. 2005 Surgeon General’s Updated Recommendations: • Women who are pregnant should not drink. • A woman who has already consumed alcohol during pregnancy should stop to avoid further risks. • Women who are at risk for or are trying to become pregnant should not consume alcohol. • Health professionals should work with all women of child bearing age to reduce risk.

6. Fetal Alcohol Spectrum Disorders FAS ARND PFAS Fetal Alcohol Syndrome –only term diagnosed by health care providers Partial Fetal Alcohol Syndrome Alcohol-Related Neurodevelopmental Disorder

7. Fetal Alcohol Syndrome (FAS) represents only the “tip of the iceberg” relative to allalcohol-related effects

8. FASD By The Numbers • 1% of all births (40,000 newborns each year). • Lifetime cost for one individual with FAS is at least $2 million. • Cost to the nation up to $6 billion each year for FAS alone. U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration 2007

9. All Alcohol-Related Effects US Census Bureau

10. Alcohol is a Teratogen • An agent that interrupts or alters the normal development of the fetus • “Of all the substances of abuse (including cocaine, heroin and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.” Institute of Medicine, 1996

12. Manifestations of CNS Dysfunction Associated with FAS • Attention/memory problems • Hyperactivity • Learning disabilities • Behavior Problems • Microcephaly • Language & speech problems • Altered muscle tone • Poor fine & gross motor coordination • Mental retardation

13. FASD Through the Life SpanSchool Issues and Concerns

14. Developmental OverviewEarly School Age • Continued sleep problems • Making and keeping friends • Reading social cues • Boundary issues • Doesn’t understand stranger safety • Easily frustrated/tantrums • Understanding cause/effect relationships • Language/Speech • low receptivity/high fluency • Math problems (time/money)

15. Developmental OverviewSchool Age • Attention and memory problems • Learning problems (especially arithmetic) • Uninhibited/impulsive • Distractible • Lack of organizational skills • Developmental delays • Poor coordination

16. FAS Developmental OverviewAdolescence and Adults • Anxiety and depression • Lying and Stealing • Antisocial behavior • Poor judgment • Mood swings • Naïve - victimization • Socially inappropriate behaviors

17. FAS Adolescents & AdultsClinical Implications • Poor judgment…………………easily victimized • Attention deficits………….unfocused/distractible • Arithmetic disability……….can’t handle money • Memory problems….......doesn’t learn from experience • Difficultly abstracting……..doesn’t understand consequences • Disoriented in time and space….fails to perceive social cues • Poor frustration tolerance……..quick to anger

18. Potential “Secondary Disabilities” • Early school drop-out • Alcohol and drug abuse problems • Having children they can’t care for • Joblessness • Trouble with law • Mental health problems • Premature death

19. Why Teach About FASD • Providing age appropriate education before conception can help reduce the risk of alcohol-exposed births. • Schools exercise a powerful influence over young people, making them ideal settings to educate about the dangers of drinking alcohol during pregnancy • Alcohol remains the number one drug of choice among the Nation’s youth

20. Approximately 20% of sexually active teenage girls (15-19) become pregnant each year in the U.S. • In 2004, the rate of past month binge drinking among pregnant women age 15 to 17 (8.8%) was more than twice that of pregnant women ate 26 to 44 (3.8%). U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration 2007

21. K-12 Lesson Plans • What Teachers Need to Know • Learning about Fetal Alcohol Spectrum Disorders (FASD) • Signs and Symptoms of FASD • Common Identifiable Facial Features of FAS

23. K-12 Lesson Plans • Sensitivity Caution • Discussing alcohol, tobacco, and other drugs (ATOD) with students • Family Letter • 12 Steps to Success For Students With FASD. • Strategies for School Staff • Websites and Resources

24. National Organization on Fetal Alcohol Syndrome Educating the public, professionals and policymakers about alcohol use during pregnancy and supporting children and families living with the disorder National Organization on Fetal Alcohol Syndrome Educating the public, professionals and policymakers about alcohol use during pregnancy and supporting children and families living with the disorder FASD: What Everyone Should Know FASD: What Everyone Should Know Alcohol use during pregnancy is the leading known preventable cause of mental retardation and birth defects in the United States. FASD affects an estimated 40,000 infants each year - more than Spina Bifida, Down Syndrome and Muscular Dystrophy combined. Fetal Alcohol Spectrum Disorders (FASD)is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects can include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis. Fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (PFAS), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD) are terms used to describe the range of conditions associated with prenatal alcohol exposure. An FAS diagnosis indicates the most serious set of birth defects, including growth deficiency (physical), central nervous system dysfunction (mental or brain damage) and a characteristic set of facial dysmorphology or malformations. Who is at Risk? Any woman of childbearing age is at risk of having a child with an FASD if she drinks alcohol during her pregnancy. Alcohol can harm an embryo or fetus at any time, even before a woman knows she is pregnant. Many women drink early in pregnancy but stop drinking when they learn they are pregnant. Others cannot stop drinking without help. Women who have given birth to children with an FASD and continue to drink are at very high risk of having additional children with an FASD. • What Are the Effects of FASD? • Depending on the timing and frequency of maternal alcohol consumption outcomes associated with prenatal alcohol exposure may include: • Specific facial dysmorphology • Growth deficits • Brain damage including mental retardation • Heart, lung, and kidney defects • Hyperactivity and behavior problems • Attention and memory problems • Poor coordination or motor skill delays • Difficulty with judgment and reasoning • Learning disabilities • “Of all the substances of abuse (including cocaine, heroin and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”Institute of Medicine, 1996. • FASD also takes an enormous financial toll on affected families and society as a whole. Less than one-third of individuals affected prenatally by alcohol have the full FAS, yet FAS alone costs the United States $5.4 billion annually in direct and indirect costs. This is only a small portion of the total societal costs associated with FASD. • How Can FASD Be Prevented? • While there is no cure for FASD, it is 100 percent preventable when pregnant women abstain from alcohol. NOFAS prevents FASD by raising public awareness, training practitioners to screen women for alcohol disorders and teaching youth to make healthy choices, among many other strategies. Alcohol use during pregnancy is the leading known preventable cause of mental retardation and birth defects in the United States. FASD affects an estimated 40,000 infants each year - more than Spina Bifida, Down Syndrome and Muscular Dystrophy combined. Fetal Alcohol Spectrum Disorders (FASD)is an umbrella term describing the range of effects that can occur in an individual whose mother drank alcohol during pregnancy. These effects can include physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. The term FASD is not intended for use as a clinical diagnosis. Fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (PFAS), alcohol-related neurodevelopmental disorder (ARND) and alcohol-related birth defects (ARBD) are terms used to describe the range of conditions associated with prenatal alcohol exposure. An FAS diagnosis indicates the most serious set of birth defects, including growth deficiency (physical), central nervous system dysfunction (mental or brain damage) and a characteristic set of facial dysmorphology or malformations. Who is at Risk? Any woman of childbearing age is at risk of having a child with an FASD if she drinks alcohol during her pregnancy. Alcohol can harm an embryo or fetus at any time, even before a woman knows she is pregnant. Many women drink early in pregnancy but stop drinking when they learn they are pregnant. Others cannot stop drinking without help. Women who have given birth to children with an FASD and continue to drink are at very high risk of having additional children with an FASD. • What Are the Effects of FASD? • Depending on the timing and frequency of maternal alcohol consumption outcomes associated with prenatal alcohol exposure may include: • Specific facial dysmorphology • Growth deficits • Brain damage including mental retardation • Heart, lung, and kidney defects • Hyperactivity and behavior problems • Attention and memory problems • Poor coordination or motor skill delays • Difficulty with judgment and reasoning • Learning disabilities • “Of all the substances of abuse (including cocaine, heroin and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus.”Institute of Medicine, 1996. • FASD also takes an enormous financial toll on affected families and society as a whole. Less than one-third of individuals affected prenatally by alcohol have the full FAS, yet FAS alone costs the United States $5.4 billion annually in direct and indirect costs. This is only a small portion of the total societal costs associated with FASD. • How Can FASD Be Prevented? • While there is no cure for FASD, it is 100 percent preventable when pregnant women abstain from alcohol. NOFAS prevents FASD by raising public awareness, training practitioners to screen women for alcohol disorders and teaching youth to make healthy choices, among many other strategies. Muscular Dystrophy Muscular Dystrophy Spina Bifida Spina Bifida Down Syndrome Down Syndrome FASD FASD Normal Brain FAS Affected Brain Normal Brain FAS Affected Brain Harwood, Am. J. Med, Genet. 2002 Harwood, Am. J. Med, Genet. 2002 900 17th Street ▪ Suite 910 ▪ Washington, DC 20006 ▪ Phone: 202-785-4585 ▪ 1-800-66-NOFAS ▪ E-mail: info@nofas.org 900 17th Street ▪ Suite 910 ▪ Washington, DC 20006 ▪ Phone: 202-785-4585 ▪ 1-800-66-NOFAS ▪ E-mail: info@nofas.org

27. K-2

28. Skill Emphasis/Health Education Standard • Standard 2 – Students will analyze the influence of family, peers, culture, media, technology and other factors on health behaviors. • 2.2.1. Identify how the family influences personal health practices and behaviors • Standard 8 – Students will demonstrate the ability to advocate for personal, family, and community health. • 8.2.1. Make requests to promote personal health. • 8.2.2. Encourage peers to make positive health choices.

29. Teaching Steps • Read the Story Read the Karli and the Star of the Week book to students.

30. Karli and the Star of the Week • A colorfully illustrated story book that teaches youth to be tolerant and accepting of all individuals regardless of their capabilities or disabilities. • 31 Pages

31. Discussion and Group Activity • Ask students what they think about the story. • Ask students to recall the disorder, Fetal Alcohol Syndrome, discussed in story. • Ask students to think of something special about themselves • Ask students to think of something special about someone else and one of their classmates • Ask students to share something they need help with

32. Conclusion – Poem

33. 3-5

34. Skill Emphasis/Health Education Standard • Standard 1 – Students will comprehend concepts related to health promotion and disease prevention. • 1.5.1. – Describe the relationship between healthy behaviors and personal health. • 1.5.2. – Identify examples of emotional, intellectual, physical, and social health. • Standard 5 – Students will demonstrate the ability to use decision-making skills to enhance health. • 5.5.1. – Identify health related situations that might require a thoughtful decision. • 5.5.3. – List healthy options to health related issues or problems. • 5.5.5. – Choose a healthy option when making a decision.

35. Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce health risks. • 7.5.1. – Identify responsible personal health behaviors. • 7.5.2. – Demonstrate a variety of healthy practices and behaviors to maintain or improve personal health. • 7.5.3. – Demonstrate a variety of behaviors to avoid or reduce health risks. • Standard 8 – Students will demonstrate the ability to advocate for personal, family and community health. • 8.5.1. – Express opinions and give accurate information about health issues • 8.5.2. – Encourage others to make positive health choices.

36. Teaching Steps • Nutrition and Health Choices • Harmful Substances • Nutrition and Human Development • Effects of Alcohol, Tobacco, and Other Drugs (ATOD) on the Developing Fetus • Discuss Fetal Alcohol Spectrum Disorders

37. Activity #1 – CHOICES FOR A HEALTHIER LIFE Grade 3

39. Activity #2 – Healthier Living Word Search Grade 4

41. Activity #3 – Healthier Living Crossword Puzzle Grade 4 or 5

43. 6-8

44. Skill Emphasis/Health Education Standard • Standard 5 – Students will demonstrate the ability to use decision making skills to enhance health • 5.8.1. – Identify circumstances that can help or hinder healthy decision making. • 5.8.6. – Choose healthy alternatives over unhealthy alternatives when making a decision. • Standard 7 – Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce risks. • 7.8.2. – Demonstrate healthy practices and behaviors that will maintain or improve the health of self and others. • 7.8.3. – Demonstrate behaviors to avoid or reduce health risks to self and others.

45. Standard 8 – Students will demonstrate the ability to advocate for personal, family, and community health. • 8.8.1. – State a health enhancing position on a topic and support it with accurate information. • 8.8.2. – Demonstrate how to influence and support others to make positive health choices.

46. Teaching Steps • Define Fetal Alcohol Spectrum Disorders (FASD) • How Common is FASD? • Reinforce A Strong No-Use Message • Describe How FASD Can Affect the Brain • What Are the Symptoms of FASD?

47. Activity #1 – Short-Term Memory Challenge In Class Activity

49. Activity #2 – FASD Community Advocacy Project Long-Term Assignment

50. Activity #3 – Question and Answer In Class Activity