Vicki	
  Russell	
  CEO	
  
NOFASD	
  Australia	
  
Fetal alcohol spectrum
disorders: Using a fetal
alcohol-neurobehaviour...
2	
  
Objec9ves	
  
1.  Fetal	
  Alcohol	
  Spectrum	
  Disorders	
  &	
  impact	
  
across	
  the	
  lifespan	
  	
  
2. ...
3	
  
Fetal	
  Alcohol	
  Spectrum	
  Disorders	
  
&	
  impact	
  across	
  the	
  lifespan	
  	
  
	
   	
  
4	
  
Fetal	
  Alcohol	
  Spectrum	
  Disorders	
  
•  Fetal	
  Alcohol	
  Syndrome	
  (FAS)	
  –	
  1:1000	
  
•  Par9al	...
5	
  
Facts	
  
•  Dose/9me	
  rela9onship	
  across	
  	
  gesta9on	
  
•  No	
  known	
  minimum	
  ‘safe’	
  amount	
  ...
6	
  
(c)	
  NOFASARD	
  2013	
  
Paternal	
  alcohol	
  use	
  
1.  Low	
  birth	
  weight	
  
2.  Impaired	
  cogni9ve	
...
7	
  
Preven9on	
  Context	
  
1.  Society’s	
  ‘love	
  of	
  alcohol’	
  
2.  ‘Othering’	
  –	
  	
  we	
  target	
  som...
8	
  
Primary	
  characteris9cs	
  
•  Developmental	
  level	
  of	
  func9oning	
  
•  Sensory	
  systems	
  
•  Nutri9o...
9	
  
Strengths	
  	
  
Crea9ve	
  
Ar9s9c	
  
Musical	
  
Mechanical	
  
Athle9c	
  	
  
Hard-­‐working	
  
Determined	
 ...
10	
  
Secondary	
  behavioural	
  symptoms	
  
•  Easily	
  9red,	
  fa9gued	
  
•  Avoidance	
  
•  Anxious	
  
•  Lonel...
11	
  
The	
  Fetal	
  Alcohol-­‐	
  
Neurobehavioural	
  (FA-­‐NB)	
  
approach	
  
12	
  
(c)	
  NOFASARD	
  2013	
  
Malbin,	
  D	
  (2014)	
  
Into	
  Ac9on	
  
FASCETS	
  
PO	
  Box	
  69242,	
  Portlan...
13	
  
(c)	
  NOFASARD	
  2013	
  
The	
  logic	
  model	
  
•  Alcohol,	
  drugs,	
  other	
  teratogens	
  and	
  trauma...
14	
  
(c)	
  NOFASARD	
  2013	
  
The	
  conceptual	
  glue	
  
If:	
  	
  FA/NB	
  =	
  brain-­‐based	
  physical	
  dis...
15	
  
Principles	
  of	
  FA/NB	
  
1.  Can’t	
  rather	
  than	
  won’t	
  
2.  Consider	
  developmental	
  age	
  rath...
Assump9ons	
  and	
  comparison	
  
Neurotypical	
   FA-­‐NB	
  
Think	
  fast,	
  listen	
  fast	
   Process	
  slowly	
 ...
17	
  
Developing	
  &	
  implemen9ng	
  
strategies/	
  accommoda9ons	
  for	
  
community	
  case	
  management	
  &	
  ...
18	
  
Case	
  study	
   -­‐	
  Max	
  
!  17	
  years	
  old,	
  usually	
  lives	
  with	
  mother,	
  known	
  maternal...
19	
  
Behavioural	
  techniques	
  based	
  on	
  learning	
  
theory	
  are	
  used	
  in	
  all	
  systems:	
  
! Paren...
20	
  
Defini9on:	
  Secondary	
  characteris9cs	
  
	
  Secondary	
  defensive	
  behaviors	
  develop	
  over	
  
9me	
  ...
21	
  
FA/NB	
  pathway	
  
(c)	
  NOFASD	
  2013	
  
The absence of understanding + unrealistic expectations + inappropri...
22	
  
FA-­‐NB	
  is	
  not	
  the	
  “diagnosis	
  du	
  jour”	
  
Current	
  diagnoses	
  =	
  behavioural	
  symptoms	
...
Values	
  and	
  values	
  clashes	
  
Primary
characteristic
Values,
expectations
Interpretation /
Feelings
Intervention ...
24	
  
Observe	
  	
  to	
  Find	
  Pamerns:	
  	
  
Func9onal	
  neurobehavioral	
  assessment	
  
Are	
  behaviours	
  p...
25	
  
FASCETS	
  Neurobehavioural	
  screening	
  tool©	
  
1.  Developmental	
  level	
  of	
  func9oning:	
  Social	
  ...
26	
  
6.	
  Learning	
  and	
  Memory	
  	
  
0	
  1	
  2	
  3	
  4	
  5	
  	
  	
  Poor	
  short-­‐term	
  auditory	
  m...
27	
  
8.	
  Execu9ve	
  func9oning	
  	
  
0	
  1	
  2	
  3	
  4	
  5	
  	
  	
  Difficulty	
  organizing	
  and	
  plannin...
28	
  
Secondary	
  characteris9cs:	
  	
  	
  
0	
  1	
  2	
  3	
  4	
  5	
  	
  Easily	
  9red,	
  fa9gued;	
  may	
  sh...
29	
  
Ter9ary	
  characteris9cs	
  
0	
  1	
  2	
  3	
  4	
  5	
  	
  Delinquent;	
  criminal	
  involvement	
  
0	
  1	
...
30	
  
Uneven	
  development	
  adolescent	
  
Actual	
  age	
  of	
  person:	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	...
Poor	
  ‘fit’	
  =	
  problems	
  	
  
FA-­‐NB	
  Characteris5c	
   Strategy	
  –	
  expecta5on	
  	
  
Visual	
  learner	
...
32	
  
Starter	
  strategies	
  for	
  accommoda9ons	
  
1.  Think	
  brain	
  and	
  reframe	
  percep9ons	
  
2.  Observ...
Applica9on:	
  	
  	
  
Func9onal	
  Neurobehavioral	
  Assessment	
  
A	
  systema9c	
  approach	
  to	
  developing	
  p...
SeOng:	
  Custodial	
  	
   Age:	
  	
   18	
   Developmental	
  age:	
  9-­‐10	
  
1
Task or
Expectation
2
Brain
has to
3...
SeOng:	
  Jus9ce	
   Age:	
  	
  15	
  	
   Developmental	
  age:	
  	
  12	
  
1
Task or
Expectation
2
Brain has to
3
Pri...
36	
  
Addi9onal	
  starter	
  strategies	
  
1.  Stop	
  figh9ng	
  for	
  change.	
  Ask:	
  	
  What	
  if?	
  
2.  Thin...
37	
  
Review	
  
1.  FA/NB	
  is	
  a	
  brain-­‐based	
  physical	
  disability	
  
2.  Reframe	
  behaviors:	
  Neurobe...
38	
  
Provincial	
  Outreach	
  Program	
  
hmp://www.fasdoutreach.ca/elearning/modules-­‐guide/
modules-­‐guide	
  	
  
...
39	
  
References	
  	
  
!  MALBIN,	
  D	
  (2013)	
  Into	
  Ac9on:	
  A	
  Training	
  of	
  Trainers	
  in	
  a	
  
Ne...
40	
  
Na9onal	
  Organisa9on	
  for	
  Fetal	
  Alcohol	
  Syndrome	
  Disorders	
  
postal:	
  PO	
  Box	
  448,	
  Wyny...
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Vicki Russell - National Organisation for Fetal Alcohol Spectrum Disorders - Fetal Alcohol Spectrum Disorders: Using a Fetal Alcohol-Neurobehavioural (FA-NB) Approach in Working with Young People

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Vicki Russell delivered the presentation at the 2014 Younger People with very High & Complex Care Needs Conference.

The 4th Annual Younger People with very High & Complex Care Needs Conference focused on topics such as report on Summer Foundation’s preliminary findings from NDIS Launch sites in Barwon & the Hunter Valley, identify policy & practice opportunities & barriers for YPINH that arise from the NDIS.

For more information about the event, please visit: http://www.informa.com.au/youngerpeopleconference14

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Vicki Russell - National Organisation for Fetal Alcohol Spectrum Disorders - Fetal Alcohol Spectrum Disorders: Using a Fetal Alcohol-Neurobehavioural (FA-NB) Approach in Working with Young People

  1. 1. Vicki  Russell  CEO   NOFASD  Australia   Fetal alcohol spectrum disorders: Using a fetal alcohol-neurobehavioural (FA-NB) approach in working with young people Younger People with Very High and Complex Care Needs Conference, Melbourne June 2014
  2. 2. 2   Objec9ves   1.  Fetal  Alcohol  Spectrum  Disorders  &  impact   across  the  lifespan     2.  The  Fetal  Alcohol-­‐  Neurobehavioural  (FA-­‐ NB)  approach     3.  Developing  &  implemen9ng  strategies/   accommoda9ons  for  community  case   management  &  working  in  custodial   seOngs  
  3. 3. 3   Fetal  Alcohol  Spectrum  Disorders   &  impact  across  the  lifespan        
  4. 4. 4   Fetal  Alcohol  Spectrum  Disorders   •  Fetal  Alcohol  Syndrome  (FAS)  –  1:1000   •  Par9al  Fetal  Alcohol  Syndrome  (pFAS)   •  Structural  abnormali9es   •  Face,  growth,  central  nervous  system  impairments   •  Alcohol  Related  Neurodevelopmental   Disorder  (ARND)  –  1:100   •  Func9onal  deficits   •  Confirmed  fetal  alcohol  exposure   (c)  NOFASARD  2013  
  5. 5. 5   Facts   •  Dose/9me  rela9onship  across    gesta9on   •  No  known  minimum  ‘safe’  amount  of  alcohol   •  Impact  on  the  central  nervous  system     •  Every  individual  living  with  an  FASD  is  different     •  Life9me  impact  of  the  condi9on   •  Cannot  rely  on  IQ  as  measurement  of  disability-­‐  can  range  from  below   normal  to  above  average   •  A  lower  level  of  adap9ve  func9oning  (manage  daily  life)  is  common  -­‐   more  significantly  impaired  than  low  IQ   •  Mul9ple  systems  implica9ons  across  educa9on,  criminal  jus9ce,   economic  support,  employment,  child  protec9on  and  family  support   services   •  Consider  too,  the  parent  who  uses  alcohol   (c)  NOFASARD  2013  
  6. 6. 6   (c)  NOFASARD  2013   Paternal  alcohol  use   1.  Low  birth  weight   2.  Impaired  cogni9ve  skills,  increased  hyperac9vity  in  sons   of  alcoholic  fathers   3.  Changes  in  behaviors  of  sons  of  alcoholic  fathers   4.  Low  count  and  altered  structure  of  sperm   5.  Lower  rates  of  pregnancies;  sons  were  less  fer9le   6.  Decreased  ac9vity  of  sperm  and  lower  testosterone   levels   7.  Effects  on  epigene9cs,  or  expression  of  genes  on   cogni9ve  func9oning   Malbin,  FASCETS  2013  
  7. 7. 7   Preven9on  Context   1.  Society’s  ‘love  of  alcohol’   2.  ‘Othering’  –    we  target  some  mothers,  some   drinkers,  some  behaviours  because  they  are  not   us   3.  Values  and  beliefs  perpetuate  barriers  &  limit   safety  for  disclosure   4.  FA  ocen  regarded  as  the  ‘invisible’  disability  –   denial  of  the  condi9on  -­‐  too  much  reliance  on   facial  features  missing  the  neurobehavioural  part   of  the  spectrum  
  8. 8. 8   Primary  characteris9cs   •  Developmental  level  of  func9oning   •  Sensory  systems   •  Nutri9on   •  Language  and  communica9on   •  Processing  pace:    How  fast  the  brain  works   •  Learning  and  memory   •  Abstract  thinking   •  Execu9ve  func9oning   •  Strengths  
  9. 9. 9   Strengths     Crea9ve   Ar9s9c   Musical   Mechanical   Athle9c     Hard-­‐working   Determined   Persistent     Willing    
  10. 10. 10   Secondary  behavioural  symptoms   •  Easily  9red,  fa9gued   •  Avoidance   •  Anxious   •  Lonely,  isolated   •  Shut  down;  flat  affect     •  Fearful,  withdrawn   •  Depressed   •  Frustrated,  short  fuse,  angry        
  11. 11. 11   The  Fetal  Alcohol-­‐   Neurobehavioural  (FA-­‐NB)   approach  
  12. 12. 12   (c)  NOFASARD  2013   Malbin,  D  (2014)   Into  Ac9on   FASCETS   PO  Box  69242,  Portland,  OR    97239   Dmalbin@fascets.org              www.fascets.org   Malbin,  D.  (2002)  Trying  Differently    Rather  Than   Harder.  Tetrice  publica9ons.  
  13. 13. 13   (c)  NOFASARD  2013   The  logic  model   •  Alcohol,  drugs,  other  teratogens  and  trauma   kill  cells  and  cause  physical  changes  in  the   brain   •  Physical  changes  affect  the  structure  and   func9on  of  the  brain   •  Behaviors  are  usually  the  only  symptoms   •  FA/NB  is  an  invisible  physical  disability  with   behavioral  symptoms  
  14. 14. 14   (c)  NOFASARD  2013   The  conceptual  glue   If:    FA/NB  =  brain-­‐based  physical  disability  with   behavioral  symptoms   Then:  Recognize  and  provide  accommoda9ons,   same  as  for  any  other  physical  condi9on  
  15. 15. 15   Principles  of  FA/NB   1.  Can’t  rather  than  won’t   2.  Consider  developmental  age  rather   than  chronological  age  –  shics  our   expecta9ons   3.  Realis9c  expecta9ons  and   environmental  and  social   accommoda9ons/strategies   (c)  NOFASARD  2013  
  16. 16. Assump9ons  and  comparison   Neurotypical   FA-­‐NB   Think  fast,  listen  fast   Process  slowly   Predict,  plan  ahead   Difficulty  predic9ng   Mul9-­‐task,  priori9se   One  thing  at  a  9me   Learn,  remember,  apply   informa9on   Memory  problems   Inhibit  impulses   Impulsive     Ignore  and  manage  sensory   input   Easily  over-­‐s9mulated   Problem  solve   Difficulty  problem  solving  
  17. 17. 17   Developing  &  implemen9ng   strategies/  accommoda9ons  for   community  case  management  &   working  in  custodial  seOngs  
  18. 18. 18   Case  study   -­‐  Max   !  17  years  old,  usually  lives  with  mother,  known  maternal  drinking   !  Developmental  age  is  averaged  at  8,  no  FAS  ‘face’   !  Early  school  leaver  -­‐  limited  literacy  and  numeracy  skills   !  Alcohol  and  other  drug  use  issues/  financial  problems     !  Difficulty  sustaining  work   !  Periods  of  deten9on  since  12   !  Mul9ple  diagnoses  in  childhood  –  learning  disorder,  ADHD,  conduct   disorder  and  many  agencies  and  interven9ons  over  9me.  Withdrawn   services  due  to  client  ‘not  trying’   !  Case  file  indicates  inamen9on,  high  support  need,  agrees  to   obliga9ons  (work,  training  etc)  but  does  not  follow  through,   confabulates   !  Tries  hard  to  please  and  is  likeable  and  friendly  
  19. 19. 19   Behavioural  techniques  based  on  learning   theory  are  used  in  all  systems:   ! Paren9ng   ! Educa9on   ! Jus9ce   ! Mental  health   ! Addic9ons  treatment   ! Social  services   ! Others  
  20. 20. 20   Defini9on:  Secondary  characteris9cs    Secondary  defensive  behaviors  develop  over   9me  when  there  is  a  “poor  fit”  between   individual  and  environment      Defensive  behaviors  are  normal  reac9ons  to   pain  and  are  preventable            Adapted  from:      Ann  Streissguth,  1996  
  21. 21. 21   FA/NB  pathway   (c)  NOFASD  2013   The absence of understanding + unrealistic expectations + inappropriate interventions = poor ‘fit’ and complex needs Physical   brain   difference   Primary   condi9ons   Complex   needs   Secondary behaviours emerge over time and are defensive Labelling + behaviour interventions poor ‘fit’ Ter9ary   condi9ons  
  22. 22. 22   FA-­‐NB  is  not  the  “diagnosis  du  jour”   Current  diagnoses  =  behavioural  symptoms   FA/NB  =  Brain  difference  (dysfunc9on)   Iden9fica9on  redefines  behaviors   Redefines  problems     Redefines  solu9ons  
  23. 23. Values  and  values  clashes   Primary characteristic Values, expectations Interpretation / Feelings Intervention Secondary symptom Accommodation: Build on strengths Dysmaturity Act your age Being a baby, Lazy, not trying Frustrated Punish Anxiety, anger Think younger Confabulation Honesty Lying, manipulative, “At me” Fear, angry sad Punish, ground Anger, denial Recognize brain dysfunction, alter communication Memory problems Remember “Should” know!! Angry frustrated Remove privileges Anger, frustration Accept need to reteach, based on learning strengths Slow processing pace Value speed – think fast Not trying, withholding , on purpose Angry, frustrated Speed up, yell, embarrass Shut down, fear, avoidance, withdrawal SLOW DOWN! Use fewer words Difficulty generalizing, gets the piece, not the picture Know and apply concepts in different settings Breaking the rules, Should understand concepts in all settings Angry, frustrated Consequence Confusion, anxiety, frustration anger Show rather than tell, reteach in different settings
  24. 24. 24   Observe    to  Find  Pamerns:     Func9onal  neurobehavioral  assessment   Are  behaviours  primary  or  secondary?   Resist  interpreta9on   What  did  you  see?   What  happened  just  before?   Describe  the  seOng,  environment   Were  there  other  factors?  E.g.  unexpected   change?  
  25. 25. 25   FASCETS  Neurobehavioural  screening  tool©   1.  Developmental  level  of  func9oning:  Social  skills  and   adap9ve  behaviors   2.  Sensory  systems,  sensory-­‐motor  integra9on   3.  Nutri9on   4.  Language  and  communica9on   5.  Processing    pace   6.  Learning  and  Memory     7.  Abstract  thinking   8.  Execu9ve  func9oning  
  26. 26. 26   6.  Learning  and  Memory     0  1  2  3  4  5      Poor  short-­‐term  auditory  memory;  may  do  one   step  of  three-­‐step  direc9ons   0  1  2  3  4  5      Says  one  thing,  does  another,  e.g.,  “Talks  the  talk,   but  doesn’t  walk  the  walk”   0  1  2  3  4  5      Inconsistent  performance:  “On”  and  “off”  days,   “A”  on  Monday,  “F”  on  Wednesday   0  1  2  3  4  5      Needs  to  be  retaught  the  same  thing  many  9mes     0  1  2  3  4  5      Learns  a  rule  in  one  seOng,  may  not  apply  it  in  a   different  place   0  1  2  3  4  5      Has  trouble  remembering  and  learning  from  past   experiences  
  27. 27. 27   8.  Execu9ve  func9oning     0  1  2  3  4  5      Difficulty  organizing  and  planning  a  day   0  1  2  3  4  5      Difficulty  geOng  started  or  finishing  mul9-­‐step  tasks   0  1  2  3  4  5      SeOng  goals  and  planning  the  steps  to  achieve  them  is  hard   0  1  2  3  4  5      Gets  “stuck,”  has  difficulty  stopping  doing  something  -­‐-­‐  “Can’t   let  go”  in  an  argument   0  1  2  3  4  5      Has  trouble  transi9oning,  shicing  gears;  may  become  angry   when  interrupted       0  1  2  3  4  5      Upset  by  unexpected  change  in  tasks,  schedule  or  rou9ne   0  1  2  3  4  5      Upset  by  changes  in  environments,  e.g.,  desks  or  furniture   moved,  subs9tute  teacher   0  1  2  3  4  5      Impulsive,  difficulty  inhibi9ng  responses   0  1  2  3  4  5      Difficulty  making  links:  Hearing  into  doing,  seeing  into  wri9ng,   thinking  into  talking  
  28. 28. 28   Secondary  characteris9cs:       0  1  2  3  4  5    Easily  9red,  fa9gued;  may  show  as  overac9vity,  irritability,  and/or  tantrums     0  1  2  3  4  5    Anxious   0  1  2  3  4  5    Lonely,  isolated   0  1  2  3  4  5    Shut  down;  flat  affect     0  1  2  3  4  5    Fearful,  withdrawn   0  1  2  3  4  5    Depressed   0  1  2  3  4  5    Frustrated,  short  fuse,  angry         0  1  2  3  4  5    Gets  in  trouble  if  easily  manipulated  and  set  up  by  others   0  1  2  3  4  5    Self-­‐harming  behaviors   0  1  2  3  4  5    Avoidant,  runs  away   0  1  2  3  4  5    Remarkable  sexual  ac9vity;  mul9ple  partners;  unplanned  or  teen  pregnancy   0  1  2  3  4  5    Aggressive   0  1  2  3  4  5    Destruc9ve  (not  due  to  curiosity  or  just  taking  things  apart)   0  1  2  3  4  5    Disrup9ve  in  class  or  at  work,  secondary  to  anxiety  or  frustra9on   0  1  2  3  4  5    Talks  back,  is  argumenta9ve,  secondary  to  cogni9ve  inflexibility    
  29. 29. 29   Ter9ary  characteris9cs   0  1  2  3  4  5    Delinquent;  criminal  involvement   0  1  2  3  4  5    Trouble  at  home   0  1  2  3  4  5    Trouble  at  school  or  in  the  community   0  1  2  3  4  5    Social  services  involvement   0  1  2  3  4  5    Legal  system  involvement   0  1  2  3  4  5    Alcohol  /  drug-­‐related  problems,   addic9ons   0  1  2  3  4  5    Other  problems  
  30. 30. 30   Uneven  development  adolescent   Actual  age  of  person:                                          18   Developmental  age-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐9   Strengths  (art,  sports)-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐24   Expressive  language-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐20   Recep9ve  language-­‐-­‐-­‐-­‐8   Reading  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐14   Comprehension  -­‐-­‐-­‐-­‐-­‐-­‐7  
  31. 31. Poor  ‘fit’  =  problems     FA-­‐NB  Characteris5c   Strategy  –  expecta5on     Visual  learner   Verbal  instruc9on   Processes  informa9on   slower   Fast  paced,  mul9ple  instruc9ons   Needs  external  support   Work  independently   Difficulty  organising   Organised  and  able  to  priori9se   Concrete  thinker   Abstract  –  9me,  cost,  impact  on   others  
  32. 32. 32   Starter  strategies  for  accommoda9ons   1.  Think  brain  and  reframe  percep9ons   2.  Observe  pamerns  of  behaviour/s   3.  Iden9fy,  build  on  strengths   4.  Write  the  case  plan  for  the  environment:     modify  environments  for  a  good  “fit”   5.  Collaborate,  coordinate    
  33. 33. Applica9on:       Func9onal  Neurobehavioral  Assessment   A  systema9c  approach  to  developing  person-­‐ specific  accommoda9ons  in  all  seOngs  and   managing  the  complexity  of  FA-­‐NB   33
  34. 34. SeOng:  Custodial     Age:     18   Developmental  age:  9-­‐10   1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age (est.) 5 Secondar y behaviors 6 Strengths 7 Accommodations 34
  35. 35. SeOng:  Jus9ce   Age:    15     Developmental  age:    12   1 Task or Expectation 2 Brain has to 3 Primary symptoms FA/NB 4 Devel. Age 5 Secondary behaviors 6 Strengths 7 Accommodations Understand rights Understand abstract concepts Difficulty with abstractions 12 Compliance Concrete, literal Simplify. Show up for court dates or appointments Plan, manage time, filter out other issues that arise - priorise Difficulty with executive functions, planning 14 Denial, defense, blame Willing, relational Utilize “external brain” to prevent problems Comply with orders Remember what needs to be done, generalize Poor memory, difficulty generalizing 15 Breach , anger, avoidance, aggression Determined, persistent Reduce number of tasks, show rather than tell Learn from mistakes Store, retrieve, apply information, inhibit impulses Difficulty, retrieving, applying information, impulsive 10 Re-offend Wants to please Establish informed networks to prevent problems 35
  36. 36. 36   Addi9onal  starter  strategies   1.  Stop  figh9ng  for  change.  Ask:    What  if?   2.  Think  younger   3.  Give  9me   4.  Recognize  strengths   5.  Slow  down  speech  –  use  less  words   6.  Be  direc9ve,  say  what  you  mean     7.  Use  visual  supports  –  hand  signs,  simple  drawings   or  photographs   8.  Don’t  give  too  many  choices   9.  Re-­‐teach,  remind  on  a  regular  basis  
  37. 37. 37   Review   1.  FA/NB  is  a  brain-­‐based  physical  disability   2.  Reframe  behaviors:  Neurobehavioral  Screen   -­‐  primary,  secondary  and  ter9ary  symptoms   3.  Applica9on:    Fit  and  accommoda9ons     Func9onal  neurobehavioral  assessment  
  38. 38. 38   Provincial  Outreach  Program   hmp://www.fasdoutreach.ca/elearning/modules-­‐guide/ modules-­‐guide     •  Learning  about  FASD  (including  Kim  Barthel  –  Speaking  about   the  Brain  and  Amachment)   •  Planning  Instruc9on  for  schools   •  Crea9ng  Posi9ve  Behaviour  Climate   •  Teaching  to  Strengths  and  Needs  Developing  individual   educa9on  programs   •  Transi9oning   •  Assessment  networks   (c)  NOFASARD  2013  
  39. 39. 39   References     !  MALBIN,  D  (2013)  Into  Ac9on:  A  Training  of  Trainers  in  a   Neurobehavioural  Approach.  Portland,  Oregon  12-­‐15th  March  2013   !  MALBIN,  D.  (2002)  Trying  Differently  Rather  Than  Harder,  Tetrice   !  STREISSGUTH,  A.  (1997)  Fetal  Alcohol  Syndrome:  A  Guide  for  Families   and  CommuniAes.  Brookes:  USA  (Fich  Prin9ng  2003)   !  STREISSGUTH,  A.P.,  &  KANTER,  J.,  (eds.)  (2002)  The  Challenge  of  Fetal   Alcohol  Syndrome:  Overcoming  Secondary  DisabiliAes.  University  of   Washington  Press:  Seamle  and  London   (c)  NOFASARD  2013  
  40. 40. 40   Na9onal  Organisa9on  for  Fetal  Alcohol  Syndrome  Disorders   postal:  PO  Box  448,  Wynyard  TAS  7321   telephone:  1300  306  238   email:  admin@nofasd.org.au   website: www.nofasd.org.au     ABN  :  93  833  563  942   Patron:  Her  Excellency  Dame  Quen9n  Bryce   Please consider joining our network of supporters through our website

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