This document summarizes challenges faced by children with prenatal exposure to alcohol and drugs, including fetal alcohol spectrum disorders. It outlines cognitive, behavioral and mental health issues these children often experience, such as difficulties with executive function, impulse control, memory and learning. It provides strategies for caregivers to support these children, including structured routines, clear rules/expectations, breaking tasks into smaller chunks, and teaching skills like problem-solving and emotional regulation. The document emphasizes that these children benefit from stable, predictable environments with consistent support.

1. Brenda McCreight, Ph.D.
Overview of Childhood Mental Health
Disorders & Pre-Natal Exposure to
Alcohol & Drugs

2. Fetal Alcohol Brain

3. NAS affected brain

4. Characteristics of Fetal Alcohol
Syndrome
1. Challenges :academic
:adhd
:speech/language
:information processing
:patterning
:sequencing *

5. Characteristics of Fetal Alcohol
Syndrome
2. Short impulse control 8. Confusion under pressure
3. Inability to relate 9. Difficulty grasping
behavior to abstract concepts
consequences 10. Inability to manage
4. No sense of connection to anger
societal rules 11. Poor judgement
5. Poor short term memory 12. Appear to be stubborn
6. Inconsistent knowledge 13. Cannot generalize *
base
7. Poor personal boundaries

6. Fetal Alcohol Syndrome
! Facial dysmorphology ! Learning disabilities
! Central nervous and/or cognitive
system impairment impairment
! Inability to generalize ! Impulsivity
! Inability to perceive ! Memory impairment/
patterns/ sequences inconsistent memory
! Poor judgement ! Inconsistent
knowledge base
! Poor boundaries *

7. Executive Function
~ Goal formation
~ Planning
~ Carrying out goal-directed plans
~ Effective performance *

8. Secondary Challenges
* Mental Health Issues Over 90%
* Disrupted school experience Over 60%
* Trouble with the law Over 60%
* Confinement Over 50%
* Inappropriate sexual behavior Over 50%
* Alcohol/drug problems Over 30%
* Problems with employment Over 80%
* Problems with independent living Over 80%
(Streissguth, Kogan and Bookstein, 1996) *

9. Characteristics of children with
pre-natal exposure to drugs
~ Extreme behaviors ~ Lack of fear
~ Lack of patience ~ Lack of remorse
~ Lack of initiative ~ Short attention span
~ Poor social skills ~ Cannot make transitions
~ Poor impulse control ~ Ritualized behaviors
~ Pre-occupied by subjects ~ Aggression
~ Tendency to perseverate ~ Oppositional behaviors
~ Sensory challenges ~ Incomplete attachment
~ Cannot play ~ Cannot relate behavior to
consequences *

10. Pre-Natal Marijuana Exposure
Impacts pre-frontal brain function
+ Reasoning
+ Mood regulation
+ Abstract thought
After age three
+ Executive function impaired
+ Attention behavior
+ Visual analysis/hypothesis testing *

11. 1 in 10 children in the U.S. has a
mental illness severe enough to
cause some level of impairment.
(National Institute of Mental Health, U.S., 2000) *

12. Depression
1 in 33 children, 1 in 8 adolescents
! Persistent sadness ! Difficulty
and/or irritability concentrating
! Low self-esteem ! Physical ailments
! Loss of interest in ! Increase or decrease
normally enjoyed in overall activity level
activities ! Suicidal ideation or
! Change in appetite attempts *
and/or sleeping
patterns

13. Conduct Disorder
Aggression to people or animals
Destruction of property
Deceitfulness and/or theft
Serious violation of rules in the home, the
community and school *

14. Intermittent Explosive Disorder
! Incidents of acts of aggression that result
in serious assaults against people or
property
! The degree of aggression is grossly out of
proportion to the triggers *

15. Oppositional Defiant Disorder
! Frequent loss of ! Blames others
temper ! Easily annoyed by
! Argumentative others
! Openly defiant and ! Angry and resentful
non-compliant ! Spiteful and
! Deliberately annoys vindictive*
others

16. Obsessive Compulsive Disorder
! Recurring and persistent ! Driven to repeat the
thoughts, images, behaviors, such as
impulses that are beyond
hand washing,
normal worries and are
intrusive and create blinking, repeating
anxiety and/or words silently,
depression checking on items,
! Are time consuming and etc. And must be done
interfere with daily so according to rigid
activities rules *

17. Bipolar Disorder
! An expansive or ! Over or under
irritable mood that sleeping
changes rapidly ! Impaired judgement,
! Depression impulsivity
! Rages ! Dare-devil behaviors
! Defiance of authority ! Craving for
! Agitation, carbohydrates
distractibility ! Delusions and
hallucinations *

18. Tourette Syndrome
! Repeated and ! Symptoms can include-
involuntary body rapid eye blinking, throat
clearing, sniffing, rapid
movements
movement of arms and
! Uncontrollable legs, yelling, yelping,
vocalizations jumping, touching things,
smelling things or people,
hitting or biting self,
copralalia (swearing),
compulsions and
ritualistic behaviors,
attention deficit disorder.*

19. Interacting Factors for
Relationship Formation
Sense of other > the ability to perceive
others
Attachment > ability to engage in
reciprocal relationships
Emotional regulation > ability to self-
regulate affect and to self-monitor *

20. Perception of the relationship is
filtered through>
· Genetics
· Biology
· Neurological systems
· Development level/stage
Environment *

21. Lack of an “inner place” results in >
No place to return to Cannot postpone anything
Inability to consider because it disappears
options when the person is not
thinking about it
No predictability
Changing your mind feels
Cannot regulate thought
like losing your mind
Cannot priorize
Past is not connected to
Cannot contemplate the the present
future
Fill the inner place with
Context sensitive addictive, behaviors and
compulsions *

22. Strategies
Prioritize the learning and emotional needs
for each:
> Year
> Month
> Week
> Day
> Hour *

23. Strategies
Plan for some fun/success in each day
Provide a reduced stimulation work-station
Allow for fidgeting, restlessness, boredom
Make each learning activity short
Give concrete instructions/use concrete
language
Break tasks down into smaller chunks *

24. Strategies
Make the rules and consequences clear and
consistent
Reduce choices/teach choices
Use in/out baskets for work
Remind the child of the schedule each day
Prepare ahead for change in routine
Teach sequencing *

25. Strategies
Teach generalization
Use the child’s language
Teach how to make a checklist, keep a
calendar
Teach the most difficult subjects during the
child’s most productive part of the day *

26. Strategies
Watch for irritability, mood swings- be
proactive
Be aware of peer problems- alienation,
isolation, depression
Repeat, re-teach, retrain
Stop using anything that does not work *

27. Strategies
Emotional age and chronological age may be
very different
Develop strategies for “freezing”
Experiment with different strategies
Find a mentor or support group *

28. Strategies
Reduce homework/work with parents on
homework
Make the child a partner in his/her education
and therapy *

29. Qualities
» Demonstrate flexibility/adaptability
» Well informed/trained on adoption
dynamics and issues
» High self-esteem in mother or primary
caregiver
» Ability to accept difference
» Resolution of own past traumas *

30. Qualities
» Demonstrate stress management skills
» Demonstrate strong advocacy skills
» Demonstrate problem solving skills
» Have strong support network
» Sense of humor
» Are older *

31. Qualities
Single Parent
– economic security
– job flexibility
– good self-care skills
– babysitting/respite/back-up *

32. Interventions
Provide a stable, predictable, controlled
environment
Create possibility for attachment
Teach problem solving and conflict resolution
Create successful dependence
Set up opportunities for success
Consistent reminders of the “rules”
Teach how to act attached *

33. Key Words for Care Providers
» Patience
» Schedule
» Routine
» Consistency
» Care with transitions
» Structure
» Repetition
» Control of the environment *

34. Symptoms of NAS Withdrawal
– Wakefulness
– Irritability
– Tremors, body temperature varies
– High pitched cry
– Hypertonia
– Diarrhea
– Respiratory distress
– Apnea
– Weight loss or slow weight gain *

35. Common Challenges for Pre-
Natally Exposed Toddlers
~ Hypersensitivity ~ Disorganized behaviors
~ Tactile defensiveness ~ Irritability
~ Eye contact avoidance ~ Poor social interaction
~ Rocking skills
~ Sound avoidance ~ Excessive muscle tone
~ Seizure disorder ~ Abnormal posturing
~ Cardiovascular problems ~ Upper respiratory
problems
~ Delayed language
~ Fragile immune system *
~ Hyperactivity/attention
problems

36. Management and Interventions
• Normalize activity and • Simple Interventions
behaviors • 30% to 50% of babies
• Create an effective will improve with only:
feeding pattern • Swaddling to reduce
• Stabilize weight sensory overload
• Frequent small feedings
• Create calm and of an enhanced formula
ability to sleep • Close monitoring of vital
signs *

37. Impact
Toddlers > Less security attached
(ages12-30 months) to caregivers
+ Play was less age > Language and/or
appropriate behavioral problems
· more limited > Cannot tolerate
· more impulsive frustration
· throwing and batting > Distractible
objects > Disorganized
behavior*

38. Impact
Pre-School (ages 3-5 years)
> Highly sensitive to environment
> Language delays
> Poor task organizing and processing
> Poorly attached to caregiver
> Poor social skills
> Aggression/passivity *

39. Impact
– Highly sensitive to environment
– Language delays
– Poor task organization and processing
– Poorly attached to caregiver
– Poor social skills
– Aggression/passivity *

40. You can check out other services and products at these sites:
http://www.lifespancounselling.com
http://www.theadoptioncounselor.com
http://www.hazardousparenting.com
The Hazardous Parenting facebook site
Udemy.com (search under Brenda McCreight)
Slideshare.com (search under Brenda McCreight)
Amazon.com (search under Brenda McCreight)
brendamccreight@gmail.com
Brenda provides counselling and parent coaching worldwide via skype, telephone, and
email. Please contact her if you would like to book an appointment.

41. Brenda McCreight, PhD.