EPSE 317 Fetal Alcohol Spectrum Disorder (FASD)
<ul><li>https://mediamill.cla.umn.edu/mediamill/embed/16409   </li></ul>
Some Things FASD is NOT! <ul><li>Only found among poverty and certain races. </li></ul><ul><li>Hereditary </li></ul><ul><l...
One More Thing FASD is NOT <ul><li>Quote:  “FASD is what I  have , not what I  am .” </li></ul>
Prevalence <ul><li>FASD is now thought to affect between 2 and 5 percent of the school-age population of North America and...
Fetal Alcohol Spectrum Disorder (FASD) Fetal Alcohol Syndrome (FAS) Alcohol-related Birth Defects (ARBD) Partial Fetal Alc...
What is FASD? <ul><li>Growth retardation in some of affected population  (FAS, pFAS)  </li></ul><ul><li>Facial atypicaliti...
Four Domains  <ul><li>Growth  </li></ul><ul><ul><li>Height or weight (under 10 th  %ile) </li></ul></ul><ul><li>Face </li>...
Diagnosis: <ul><li>Diagnosis is multidisciplinary— must  involve at least the first two of the following: </li></ul><ul><l...
Diagnosis in BC <ul><li>In BC, a recognised diagnosis must be through a specifically established clinic. </li></ul><ul><li...
Facial characteristics Government of British Columbia, Ministry of Education, Special Programs Branch (1996)  Teaching Stu...
FAS FACIAL FEATURES
Colton Harris-Moore
Alcohol exposure and the brain From Clarren, 1978
Corpus callosum abnormalities Mattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995
Brain Function <ul><li>When psychologists assess a person with FASD, they look at a number of “functional domains.” </li><...
Seven Domains <ul><li>Cognition </li></ul><ul><li>Adaptation  </li></ul><ul><li>Executive function  </li></ul><ul><li>Memo...
Cognition <ul><li>Caution!!!  IQ is a very unreliable predictor of functional ability among people with FASD </li></ul><ul...
Subdomains <ul><li>IQ is not a single entity--different areas of intelligence are tested. </li></ul><ul><li>Verbal abiliti...
<ul><li>In most people, subdomains are more or less even </li></ul><ul><li>Among people with FASD, there tends to be a dis...
Adaptation:  How Does the Person Use Intelligence for Daily Living? <ul><li>Among most of the population IQ and adaptation...
Executive Function <ul><li>The ability to organise one’s skills.  Planning, working memory, organisation, inhibition, init...
Executive  functions <ul><li>Sequencing and planning—how to initiate a task, what steps are involved in completion, when t...
Also related to EF <ul><li>Working memory. Holding information in mind while performing action on it. </li></ul><ul><li>At...
Memory <ul><li>Not a single factor </li></ul><ul><li>Short-term/long-term/working memory </li></ul><ul><li>Storage/retriev...
<ul><li>Memory can be intermittent—here today, gone tomorrow </li></ul><ul><ul><li>Reteach, keep calm </li></ul></ul><ul><...
Communication <ul><li>Language impairments are very common among alcohol-affected children and adults. </li></ul><ul><li>T...
Why is Norbert so controlling? <ul><li>What happens if you lack receptive language? </li></ul>
Communication is a Biggie-- More  <ul><li>Psychological testing may not be sensitive enough to identify language problems ...
Communication is More Than Language <ul><li>Pragmatics--how language is used </li></ul><ul><li>Nonverbal cues </li></ul><u...
Attention/Activity Level <ul><li>Often  a problem </li></ul><ul><li>FASD and ADHD can coexist </li></ul><ul><li>Or attenti...
Achievement <ul><li>Academic achievement can be misleading </li></ul><ul><li>Students can have limited ability to generali...
Some Effects of Brain and Central Nervous System Damage (mostly) … and some hints about what to do about them
Vision <ul><li>Visual impairment (poor eyesight) </li></ul><ul><li>And/or </li></ul><ul><li>Visual perception </li></ul>
 
 
What to do?  Try: <ul><li>Provide a visually quiet space for learning. </li></ul><ul><li>Look from student’s eye level for...
Lighting <ul><li>Florescent lights can be a problem both visually and auditorially. </li></ul><ul><li>Try for natural ligh...
Hearing impairments <ul><li>Can be either problems of acuity or perception. </li></ul><ul><li>Hypersensitive hearing  (hyp...
Hearing impairments <ul><li>Can be either problems of acuity or perception. </li></ul><ul><li>Hypersensitive hearing  (hyp...
Try: <ul><li>Listen for distracting noises- </li></ul><ul><ul><li>Gurgling fish tank </li></ul></ul><ul><ul><li>Hallway no...
Hypersensitivity (over-sensitivity) <ul><li>Children may be very uncomfortable with being touched or held </li></ul><ul><l...
Cautions: <ul><li>Don’t touch child without his/her knowing you’re about to. </li></ul><ul><li>Be aware of smells, includi...
Hyposensitivity (Under-sensitivity) <ul><li>Dangerously high pain threshold </li></ul><ul><li>Insensitivity to extremes of...
Cautions <ul><li>Hyper- and hypo- can coincide </li></ul><ul><li>Interpret sensory seeking behaviour as such rather than a...
Students may mature at uneven rates: <ul><li>Chronological age: 15 </li></ul><ul><li>Expressive language of a 17-year old ...
Reading <ul><li>Essential skill </li></ul><ul><li>Most kids with FASD can learn to read </li></ul><ul><li>Comprehension ca...
Math <ul><li>Best approached as applied skill </li></ul><ul><li>Cooking </li></ul><ul><li>Use of supermarket flyers for sh...
Visual Timer
<ul><li>Time as sequence of events rather than duration: </li></ul><ul><ul><li>“ After lunch,” rather than “in an hour.” <...
 
Teach transitions explicitly <ul><ul><li>Limitations of episodic visual schedules </li></ul></ul>
Social Safety <ul><li>Minimal or no stranger awareness </li></ul><ul><li>Optimally, keep student occupied and observed </l...
 
It’s not easy… <ul><li>It’s less difficult than attempts at reactive behavioural change. </li></ul><ul><li>It’s more produ...
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Class 5 (Fasd Ppt)

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  • Talk about the Italian study, here Nevertheless, the rates of FASD identified in Italy have been higher than were predicted by the scant literature on FAS in Italy [May et al., 2006a,b] and other mainstream Western European populations. The proportion of PFAS cases far exceeds those of FAS in Italy. The rates of FAS reported from the Italian studies ranged from 3.7 to 9.2 per 1,000, PFAS from 15.7 to 43.8 per 1,000, and the prevalence of total FASD is estimated as 2-- 5.5% in the first grade children.
  • A little about the Spectrum idea, here
  • Note that other areas of growth can be affected; Cardiac Genitourinary Bone structure Dentition And recently, immune system
  • epicanthic fold , epicanthal fold , or epicanthus is a skin fold of the upper eyelid , from the nasal bone to the inferior side of the eyebrow , covering the inner corner ( medial canthus ) of the eye . It is a normal trait for a large percentage of humans . This lower fold of the upper eyelid gives the eyes of some East Asians an appearance which seems relatively narrower and almond -like in comparison to most persons of Western (Caucasian) and Sub-Saharan African descent, whose eyes seem wider due to a higher upper eyelid fold. The term &amp;quot;epicanthic fold&amp;quot; refers to a visually categorized feature of the eyelid; however, there are different underlying explanations of the causes. For instance, one theory is based on the fact that the fold is almost always associated with absent to near-absent brow ridges and vice versa , thus causing some to posit that the absent brow ridge is responsible for the occurence of the fold.
  • This is “full fas” It only represents about 10% of the affected population. Facial markers usually fade with age and are uncommon among adults. Not as easy to recognise as it would seem: Story re guy who was stealing airplanes last October…
  • Background One anomaly that has been seen in FAS is agenesis of the corpus callosum. While not common, it occurs in FAS cases (~6%) more frequently than in the general population (0.1%) or in the developmentally disabled population (2-3%). In fact it has been suggested that FAS may be the most common cause of agenesis of the corpus callosum. In the top left picture, is a control brain. The other images are from children with FAS. In the top middle the corpus callosum is present, but it is very thin at the posterior section of the brain. In the upper right the corpus callosum is essentially missing. The bottom two pictures are from a 9 year old girl with FAS. She has agenesis of the corpus callosum and the large dark area in the back of her brain above the cerebellum is a condition known as coprocephaly. It is essentially empty space. Most children with FAS do have a corpus callosum, although it may be reduced in size. The reduction in size occurs primarily in the front and rear portions (genu and splenium). One interesting item is that this same pattern of reduction in the genu and splenium has been found in ADHD children. The behavioral problems seen in FAS frequently are similar to those seen in ADHD. References Mattson, S. N., Jernigan, T. L., &amp; Riley, E. P. (1994a). MRI and prenatal alcohol exposure. Alcohol Health &amp; Research World, 18 (1), 49-52. Mattson, S. N., &amp; Riley, E. P. (1995). Prenatal exposure to alcohol: What the images reveal. Alcohol Health &amp; Research World, 19 (4), 273-277. Riley, E. P., Mattson, S. N., Sowell, E. R., Jernigan, T. L., Sobel, D. F., &amp; Jones, K. L. (1995). Abnormalities of the corpus callosum in children prenatally exposed to alcohol. Alcoholism: Clinical and Experimental Research, 19 (5), 1198-1202.
  • Low IQ protective factor—why?
  • Linkage of cause &amp; effect…
  • 3:54
  • 3:31
  • Language disabilities often do not appear until child is out of primary grades. Masked by articulation disorders (craniofacial stuff) Masked by interpretations of behaviour. 3:31
  • 5:08
  • 3:02; 4:43
  • Note that although response to stimulus may seem out of proportion, the distress is real.
  • 2:12 on video Social implications
  • Caution re “whole language” –inferring meaning can be a problem, generally teaching decoding seems to work better
  • 7:27
  • Class 5 (Fasd Ppt)

    1. 1. EPSE 317 Fetal Alcohol Spectrum Disorder (FASD)
    2. 2. <ul><li>https://mediamill.cla.umn.edu/mediamill/embed/16409 </li></ul>
    3. 3. Some Things FASD is NOT! <ul><li>Only found among poverty and certain races. </li></ul><ul><li>Hereditary </li></ul><ul><li>An indicator that an affected child’s mother was a bad person </li></ul><ul><li>A guarantee of disaster </li></ul>
    4. 4. One More Thing FASD is NOT <ul><li>Quote: “FASD is what I have , not what I am .” </li></ul>
    5. 5. Prevalence <ul><li>FASD is now thought to affect between 2 and 5 percent of the school-age population of North America and Europe </li></ul><ul><li>It is much more of an “equal opportunity” disability than is generally acknowledged. </li></ul>
    6. 6. Fetal Alcohol Spectrum Disorder (FASD) Fetal Alcohol Syndrome (FAS) Alcohol-related Birth Defects (ARBD) Partial Fetal Alcohol Syndrome(PFAS) Alcohol-related Neurodevelopmental Disorder (ARND) (Also called Static Encephalopathy, Alcohol Exposed)
    7. 7. What is FASD? <ul><li>Growth retardation in some of affected population (FAS, pFAS) </li></ul><ul><li>Facial atypicalities in some of population (FAS, pFAS) </li></ul><ul><li>3. Brain damage (FAS, pFAS, ARND) </li></ul><ul><li>4. Confirmed history of prenatal alcohol exposure. (almost non-negotiable) (FAS, pFAS, ARND, ARBD) </li></ul>
    8. 8. Four Domains <ul><li>Growth </li></ul><ul><ul><li>Height or weight (under 10 th %ile) </li></ul></ul><ul><li>Face </li></ul><ul><ul><li>Brain </li></ul></ul><ul><ul><ul><li>Head circumference under 10 th %ile </li></ul></ul></ul><ul><ul><ul><li>Various areas of brain function </li></ul></ul></ul><ul><ul><ul><li>Neurological signs: epilepsy, tremor, tics, etc… </li></ul></ul></ul><ul><li>Alcohol exposure </li></ul>
    9. 9. Diagnosis: <ul><li>Diagnosis is multidisciplinary— must involve at least the first two of the following: </li></ul><ul><li>Paediatrician </li></ul><ul><li>Psychologist </li></ul><ul><li>Optimally, also may include </li></ul><ul><ul><li>Speech-language therapist </li></ul></ul><ul><ul><li>Occupational therapist </li></ul></ul><ul><ul><li>Physiotherapist </li></ul></ul><ul><ul><li>geneticist </li></ul></ul>
    10. 10. Diagnosis in BC <ul><li>In BC, a recognised diagnosis must be through a specifically established clinic. </li></ul><ul><li>These exist in regional centres associated with the Provincial Health Authorities, and are called CDBC (Complex Development and Behaviour Conditions) Clinics. </li></ul><ul><li>In addition, a private clinic called the Asante Centre in Maple Ridge does certain assessments. </li></ul><ul><li>See http://www.mcf.gov.bc.ca/fasd/assessment.htm </li></ul>
    11. 11. Facial characteristics Government of British Columbia, Ministry of Education, Special Programs Branch (1996) Teaching Students with Fetal Alcohol Syndrome/Effects: A Resource Guide for Teachers
    12. 12. FAS FACIAL FEATURES
    13. 13. Colton Harris-Moore
    14. 14. Alcohol exposure and the brain From Clarren, 1978
    15. 15. Corpus callosum abnormalities Mattson, et al., 1994; Mattson & Riley, 1995; Riley et al., 1995
    16. 16. Brain Function <ul><li>When psychologists assess a person with FASD, they look at a number of “functional domains.” </li></ul><ul><li>These overlap somewhat, but all contribute to how we understand and identify brain damage which is not visible. </li></ul>
    17. 17. Seven Domains <ul><li>Cognition </li></ul><ul><li>Adaptation </li></ul><ul><li>Executive function </li></ul><ul><li>Memory </li></ul><ul><li>Communication (Language and a bit more) </li></ul><ul><li>Attention </li></ul><ul><li>Achievement </li></ul>
    18. 18. Cognition <ul><li>Caution!!! IQ is a very unreliable predictor of functional ability among people with FASD </li></ul><ul><li>Possible exception: very low IQs </li></ul><ul><li>IQ can vary from severe intellectual disability to high average. </li></ul>
    19. 19. Subdomains <ul><li>IQ is not a single entity--different areas of intelligence are tested. </li></ul><ul><li>Verbal abilities </li></ul><ul><li>Nonverbal abilities </li></ul><ul><li>Speed of processing </li></ul><ul><li>Working memory </li></ul>
    20. 20. <ul><li>In most people, subdomains are more or less even </li></ul><ul><li>Among people with FASD, there tends to be a discrepancy among subtest scores. </li></ul><ul><li>Areas of strength don’t necessarily predict other areas. This leads to misunderstandings. </li></ul>
    21. 21. Adaptation: How Does the Person Use Intelligence for Daily Living? <ul><li>Among most of the population IQ and adaptation are pretty much comparable </li></ul><ul><li>Among populations with FASDs, adaptation is much lower than would be predicted by IQ </li></ul><ul><li>It can vary within itself as well. </li></ul>
    22. 22. Executive Function <ul><li>The ability to organise one’s skills. Planning, working memory, organisation, inhibition, initiation… </li></ul><ul><li>The ability to evaluate one’s own behaviour and change in response to that evaluation. (self-regulation) </li></ul>
    23. 23. Executive functions <ul><li>Sequencing and planning—how to initiate a task, what steps are involved in completion, when to quit </li></ul><ul><li>Flexibility-how to shift tasks smoothly, accept change, deal with transitions </li></ul><ul><li>Impulse control— </li></ul><ul><li>The ability to keep one’s self and materials organized, in order, predictable, etc. </li></ul>
    24. 24. Also related to EF <ul><li>Working memory. Holding information in mind while performing action on it. </li></ul><ul><li>Attention: Maintaining and switching attention, distractibility. </li></ul><ul><li>Motor control and sensorimotor processing </li></ul><ul><li>Overly concrete language. </li></ul>
    25. 25. Memory <ul><li>Not a single factor </li></ul><ul><li>Short-term/long-term/working memory </li></ul><ul><li>Storage/retrieval </li></ul><ul><li>Verbal/nonverbal </li></ul><ul><li>Abstract/concrete </li></ul><ul><li>Procedural memory </li></ul><ul><li>“ Norbert’s memory is just fine--he always remembers when we’re going to the movies!” </li></ul>
    26. 26. <ul><li>Memory can be intermittent—here today, gone tomorrow </li></ul><ul><ul><li>Reteach, keep calm </li></ul></ul><ul><ul><li>Look for multi-tasking—is the situation the same as it was yesterday? In what respects? </li></ul></ul><ul><ul><li>Implications regarding generalisation </li></ul></ul><ul><ul><li>Implications regarding use of consequences to change behaviour </li></ul></ul>
    27. 27. Communication <ul><li>Language impairments are very common among alcohol-affected children and adults. </li></ul><ul><li>They are often very talkative. </li></ul><ul><li>Expressive language is often apparently more developed than receptive language. </li></ul><ul><li>“ Norbert is so controlling! Everything has to be his way..conversation topics, play, routine…” </li></ul>
    28. 28. Why is Norbert so controlling? <ul><li>What happens if you lack receptive language? </li></ul>
    29. 29. Communication is a Biggie-- More <ul><li>Psychological testing may not be sensitive enough to identify language problems </li></ul><ul><li>SLP can identify subtle but treacherous areas of weakness </li></ul><ul><li>110 km highway with huge potholes here and there </li></ul><ul><li>Understanding language important to understand behaviour and learning in addition to possibly indicating Speech-language therapy. </li></ul>
    30. 30. Communication is More Than Language <ul><li>Pragmatics--how language is used </li></ul><ul><li>Nonverbal cues </li></ul><ul><li>Language as social interaction--initiating contact, ending contact, turn-taking. </li></ul><ul><li>Problem solving--inference, “why” questions, prediction </li></ul>
    31. 31. Attention/Activity Level <ul><li>Often a problem </li></ul><ul><li>FASD and ADHD can coexist </li></ul><ul><li>Or attentional difficulties can be a part of the brain damage of FASD </li></ul><ul><li>Sometimes but not always responsive (but not entirely) to medication. </li></ul>
    32. 32. Achievement <ul><li>Academic achievement can be misleading </li></ul><ul><li>Students can have limited ability to generalise </li></ul><ul><li>Not necessarily a predictor of skills beyond the classroom </li></ul><ul><li>Lots of challenges to achievement posed by the issues we’ve covered </li></ul><ul><li>Investment of time and energy to meeting curriculum requirements may be controversial. </li></ul>
    33. 33. Some Effects of Brain and Central Nervous System Damage (mostly) … and some hints about what to do about them
    34. 34. Vision <ul><li>Visual impairment (poor eyesight) </li></ul><ul><li>And/or </li></ul><ul><li>Visual perception </li></ul>
    35. 37. What to do? Try: <ul><li>Provide a visually quiet space for learning. </li></ul><ul><li>Look from student’s eye level for distractors </li></ul><ul><li>Keep one thing on desk at a time </li></ul><ul><li>Look for students’ own strategies (hoodies, baseball hats) </li></ul>
    36. 38. Lighting <ul><li>Florescent lights can be a problem both visually and auditorially. </li></ul><ul><li>Try for natural light (good luck in Vancouver!) </li></ul><ul><li>Incandescent lighting tends to be better. </li></ul>
    37. 39. Hearing impairments <ul><li>Can be either problems of acuity or perception. </li></ul><ul><li>Hypersensitive hearing (hyperacousis) is common. </li></ul><ul><li>Otitis media (glue ear). </li></ul>
    38. 40. Hearing impairments <ul><li>Can be either problems of acuity or perception. </li></ul><ul><li>Hypersensitive hearing (hyperacousis) is common. </li></ul><ul><li>Otitis media (glue ear). </li></ul>
    39. 41. Try: <ul><li>Listen for distracting noises- </li></ul><ul><ul><li>Gurgling fish tank </li></ul></ul><ul><ul><li>Hallway noise </li></ul></ul><ul><ul><li>Lights or screens buzzing </li></ul></ul><ul><ul><li>Plumbing </li></ul></ul><ul><li>Warn before fire drills </li></ul><ul><li>Find other way of getting class attention than: “clap, clap, clap clap clap.” </li></ul><ul><li>Watch for signs of auditory distress, in gym, music, etc. </li></ul><ul><li>Consider use of headphones or earbuds. </li></ul>
    40. 42. Hypersensitivity (over-sensitivity) <ul><li>Children may be very uncomfortable with being touched or held </li></ul><ul><li>Toothbrushing can be a real battle </li></ul><ul><li>Certain foods (temperature or texture) can be very distressing </li></ul><ul><li>Textures of fabric in clothing can be distressing. </li></ul><ul><li>Children can’t explain what’s troubling them. </li></ul>
    41. 43. Cautions: <ul><li>Don’t touch child without his/her knowing you’re about to. </li></ul><ul><li>Be aware of smells, including “coffee breath,” perfume, scented felt tips, etc. </li></ul><ul><ul><li>ICK! You don’t smoke , do you? </li></ul></ul><ul><li>Exercise tolerance re: refusal to wear socks, etc. </li></ul><ul><li>Note that this can result in over-reactions to slight touch in hallway—organise time accordingly </li></ul>
    42. 44. Hyposensitivity (Under-sensitivity) <ul><li>Dangerously high pain threshold </li></ul><ul><li>Insensitivity to extremes of hot and cold </li></ul><ul><li>May seek physical stimulation and feedback by touching or banging on things </li></ul><ul><li>May sniff things, people </li></ul><ul><li>Find socially acceptable ways for student to meet sensory needs </li></ul>
    43. 45. Cautions <ul><li>Hyper- and hypo- can coincide </li></ul><ul><li>Interpret sensory seeking behaviour as such rather than aggression or sexual acting out </li></ul>
    44. 46. Students may mature at uneven rates: <ul><li>Chronological age: 15 </li></ul><ul><li>Expressive language of a 17-year old </li></ul><ul><li>Receptive language of a 7-year-old </li></ul><ul><li>Social judgement of a 6-year old </li></ul><ul><li>Gross motor abilities of a 15-year old </li></ul><ul><li>Reading (decoding) of a 12-year old </li></ul><ul><li>Reading comprehension matching receptive language </li></ul>
    45. 47. Reading <ul><li>Essential skill </li></ul><ul><li>Most kids with FASD can learn to read </li></ul><ul><li>Comprehension can be an issue </li></ul><ul><li>Reading as a support for memory </li></ul><ul><ul><li>Lists </li></ul></ul><ul><ul><li>Labels </li></ul></ul><ul><ul><li>?? </li></ul></ul>
    46. 48. Math <ul><li>Best approached as applied skill </li></ul><ul><li>Cooking </li></ul><ul><li>Use of supermarket flyers for shopping </li></ul><ul><li>Teach time very directly </li></ul>
    47. 49. Visual Timer
    48. 50. <ul><li>Time as sequence of events rather than duration: </li></ul><ul><ul><li>“ After lunch,” rather than “in an hour.” </li></ul></ul><ul><ul><li>First math, then recess… </li></ul></ul>
    49. 52. Teach transitions explicitly <ul><ul><li>Limitations of episodic visual schedules </li></ul></ul>
    50. 53. Social Safety <ul><li>Minimal or no stranger awareness </li></ul><ul><li>Optimally, keep student occupied and observed </li></ul><ul><li>Try social safety circles, but don’t rely on them exclusively </li></ul><ul><li>Uneven maturation can be a big issue </li></ul>
    51. 55. It’s not easy… <ul><li>It’s less difficult than attempts at reactive behavioural change. </li></ul><ul><li>It’s more productive and cost-efficient in the long run. </li></ul><ul><li>It’s ethically the right thing to do. </li></ul><ul><li>It’s worth it--students with FASD can grow into contributing members of society. </li></ul><ul><li>Education is all about hope. </li></ul>
    52. 56. http://findinghope.knowledge.ca/fullscreen3.html

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