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Secondary Disabilities and Fetal Alcohol Spectrum Disorder

Secondary Disabilities and Fetal Alcohol Spectrum Disorder. Dr. Brenda Stade, PhD, APN St. Michael’s Hospital, Toronto. Introduction: Secondary Disabilities. Often secondary disabilities emerge in adolescence and adulthood

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Secondary Disabilities and Fetal Alcohol Spectrum Disorder

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  1. Secondary Disabilities and Fetal Alcohol Spectrum Disorder Dr. Brenda Stade, PhD, APN St. Michael’s Hospital, Toronto. Stade 2008 www.faseout.ca

  2. Introduction: Secondary Disabilities • Often secondary disabilities emerge in adolescence and adulthood • Secondary disabilities are believed to result from complications of undiagnosed or untreated primary disabilities Stade 2008 www.faseout.ca

  3. Introduction:Secondary Disabilities • Mental health problems • Disrupted school experiences • Easily victimized • Trouble with the law • Confinement Stade 2008 www.faseout.ca

  4. Introduction:Secondary Disabilities (cont.) • Inappropriate sexual behaviour • Alcohol and drug problems • Needing dependent living situations • Problems with employment Stade 2008 www.faseout.ca

  5. Secondary vs. Primary Disabilities • Are they the same or are they different? Stade 2008 www.faseout.ca

  6. working memory planning time perception internal ordering self-monitoring regulation of emotion motivation inhibition Executive functions ofthe prefrontal cortex Stade 2008 www.faseout.ca

  7. Secondary vs. Primary Disabilities • Impulsive and uninhibited • Passive and withdrawn one minute, switching to volatile temper tantrums the next • Unpredictable; may need 24 hour supervision • Depression, Extreme Anxiety Stade 2008 www.faseout.ca

  8. Secondary vs. Primary Disabilities • Hyperactive in non-goal directed activity • Unable to stay focused on task: to follow rules, finish household chores, school assignments or keep commitments • Genuine innocence and detached attitude Stade 2008 www.faseout.ca

  9. Secondary vs. Primary Disabilities • Impulsive – sexually inappropriate, stealing • “Short-sighted” • May expect immediate gratification • Engaging and charismatic yet creative at re-framing reality. Stade 2008 www.faseout.ca

  10. Impact of FASD Stade 2008 www.faseout.ca

  11. Experience of Living with FASD 10-year-old stated: “Learning is hard. The teachers don’t explain things (in a manner that allows her to understand).” Stade 2008 www.faseout.ca

  12. Experience of Living with FASD 18-year-old stated: “They (teachers, employers) expected me to do things I couldn’t. I have a hard time doing some things. Others (kids his age) do things easier, get through work ….” Stade 2008 www.faseout.ca

  13. Experience of Living with FASD 21-year-old stated: “It (FAS) really does effect quality of life. It affects, school working, friendships…. How does it affect me? Differently. I do things differently…..My brain is rewired differently (than others).” Stade 2008 www.faseout.ca

  14. Experience of Living with FASD 8-year-old stated: “(It’s) hard, hard to keep out of trouble, and I am not that smart. Everybody makes fun of me.” Stade 2008 www.faseout.ca

  15. Hope for Positive Outcomes 21 year old stated: “The disability happened, it’s a disadvantage. It is not a disability. I don’t like to use it as an excuse (for not participating in life)”. Stade 2008 www.faseout.ca

  16. Hope for Positive Outcomes 19 year old stated: “I don’t have the best brain. … But it still works”. Stade 2008 www.faseout.ca

  17. Protective Factors • Being raised in a nurturing stable environment • Diagnosis before age 6 • Having a diagnosis of FAS rather than ARND (Streissguth et al., 2004) Stade 2008 www.faseout.ca

  18. Interventions:Diagnosis Stade 2008 www.faseout.ca

  19. Why Diagnose? • New understanding leads to new strategies at home and other environments • Opens doors for services • Better medical management. Stade 2008 www.faseout.ca

  20. Interventions:Psychosocial Stade 2008 www.faseout.ca

  21. Interventions: Psycho-social • Mental Health Programs – behavioural, social skill development • Counselling: family doctors, social workers, nurses, adolescent paediatricians, psychiatrists, psychologists • Support Groups Stade 2008 www.faseout.ca

  22. Interventions: Psychosocial • Activities that foster confidence and social development • ? Medication Stade 2008 www.faseout.ca

  23. Interventions:Learning Stade 2008 www.faseout.ca

  24. Interventions: Facilitate Learning • Psychological Assessment • Modification of School/Job Training Programs: • Small Size of 8 to 10 • Individual Educational Plan • Resource Teacher • Job Coach Stade 2008 www.faseout.ca

  25. Six Strategies for Teaching Individuals with FASD • Structure and routine is critical • Less talk and more multi-sensory learning opportunities 3. Be concrete and don’t assume anything. Teach and re-teach Stade 2008 www.faseout.ca

  26. Six Strategies for Teaching Individuals with FASD • Facilitate language. Use specialists to help with language development. • Gross motor programming is important These students need to move. 6. Reduce stimulation, use visual cues. Stade 2008 www.faseout.ca

  27. Interventions: Facilitate Job Success • Work environment that is accepting of areas of weakness not just areas of strength • Structure • Supervision • Modified Work Hours Stade 2008 www.faseout.ca

  28. Interventions: Facilitate Independence • Identify housing that matches the individuals needs • Economic support and protection • The “External Brain” • A community that cares Stade 2008 www.faseout.ca

  29. Interventions:Strategies for Success Stade 2008 www.faseout.ca

  30. Strategies for Success • Observe patterns of behaviours • Identify strengths, skills and interests • Reframe the interpretation of behaviours • Provide structure rather than control • Establish routines and consistency Stade 2008 www.faseout.ca

  31. Strategies For Success • Build transitions into every routine • Model behaviours • Provide simple instructions or cues • Identify behaviours which indicate the accumulation of frustrations • Help develop skills for expressing feelings Stade 2008 www.faseout.ca

  32. Strategies for Success • Provide specific support for social skill development • Understand the various forms of communications • Include as many sensory modalities as possible to facilitate integration of information and experience Stade 2008 www.faseout.ca

  33. Strategies for Success • Consider information processing abilities • Reevaluate expectations and goals for the individual: Clarify whose needs are being met by the goals • Clarify goals and values for education/job training and independence Stade 2008 www.faseout.ca

  34. Strategies for Success • Advocate - Anticipate - Co-ordinate – Accept • Integration of culturally relevant values and traditions • Environment Stade 2008 www.faseout.ca

  35. Thank you! Stade 2008 www.faseout.ca

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