Title: Fetal Alcohol Spectrum Disorder: The Role of the Early Childhood Educator in Recognition
1Fetal Alcohol Spectrum DisorderThe Role of the
Early Childhood Educator in Recognition
- Dr. Barbara Fitzgerald, MD, FRCP(C)
- Clinical Assistant Professor, UBC
- Developmental Pediatrician
- Sunny Hill Health Centre for Children
- bfitzgerald_at_cw.bc.ca
2Things I have learned from my children Autho
r unknown
- A king size waterbed holds enough water to fill a
2000 sq foot house 4 inches deep
3- If you hook a dog leash over a ceiling fan, the
motor is not strong enough to raise a 42 pound
boy wearing Batman underwear and a Superman cape.
It is enough, however, if tied to a paint can, to
spread all four walls of a 20 by 20 foot room.
4- You should not throw baseballs up when the
ceiling fan is on. When using the ceiling fan as
a bat, you have to throw the ball up a few times
before you get a hit. A ceiling fan can hit a
ball a long way - The glass in windows (even double pane) does not
stop a baseball hit by a ceiling fan.
5- The spin cycle on the washing machine does not
make earthworms dizzy. - It will however, make cats dizzy.
- Cats throw up twice their body weight when dizzy.
6What is FAS?
- FAS is characterized by
- growth deficiency
- characteristic facial features
- and
- neurodevelopmental difficulties
- (secondary to prenatal brain damage)
7Why make the diagnosis?
- Prevention of secondary disabilities
- Prevention of FAS
- Greater understanding on part of caregiver/teacher
8From Dr. Ann Streissguth, 1996
9Protective Factors
- diagnosis prior to age 6
- stable home environment
- coordinated early intervention for developmental
disabilities
10Protective Factors (cont...)
- never having experienced violence against oneself
- having basic needs met for at least 13 of life
- experiencing a good quality home from age 8-12
11Triggers for AssessmentInfancy
- History of prenatal exposure (to alcohol or
polydrug exposure) - Non-specific presentation
- Fussy, colicky or sleepy
- Floppy
- Poor weight gain despite adequate caloric intake
- Poor suck
- Poor state regulation
12Triggers for AssessmentPreschoolers
- Speech and language delay
- Unable to follow verbal instructions
- Fine motor skill delay
- Poor gross motor coordination (especially
balance) - Decreased attention span
- Impulsivity
- Hyperactivity
13Triggers for AssessmentPreschoolers (cont...)
- Sensory issues - easily over stimulated,
bothered by noises, textures - Difficulty with transitions
- Routine bound
- Social skills immaturity
14Triggers for AssessmentPreschoolers (cont...)
- Learning
- Inconsistent
- Unable to generalize from one situation to
another - Dont learn from mistakes
- Better at visual skills than verbal
15Behaviour how does it differ from young
children who have simple ADHD or developmental
delay
- More unpredictable
- Emotionally labile cant predict decompensation
- Good days/bad days
- Commonly used behaviour modification techniques
dont work, or only work for short periods - Cause and effect relationships not appreciated
- good behaviours are not generalized
- Rules are parroted but not internalized
16Triggers for ReferralEarly School age (K-3)
- Speech and language delay (appears to be
resolving) - Clumsy
- Hyperactive, impulsive, inattentive (?ADHD)
- Difficulties with phonics
- Difficulties with math
- Poor social skills
- Seem generally less mature than same-age peers
17Triggers for ReferralLater School Age (Grades
4-7)
- More disruptive/inattentive behaviour
- Dont get any work done without 11 attention
- Grades may drop
- School suspensions
- Oppositional behaviour
- Emerging conduct problems/anti-social behaviour
- depression
18Triggers for ReferralAdolescence
- Discouragement, low self-esteem
- School failure/dropout
- Conduct disorders/trouble with the law
- Lack of friends
- Sexual inappropriateness
- Depression, other mental health issues
- Obvious lack of maturity compared to peers
- Poor judgement
19The Assessment ProcessWhat to expect
- Physician
- Complete history of parental and teacher concerns
- Physical exam especially growth, facial
characteristics and neurological exam
20The Assessment (cont...)
- Psychologist
- 1. Cognitive Skills Assessment
- I.Q. test (e.g. WISC III) looking at verbal
problem solving abilities and non-verbal skills
(visual perceptual, visual-spatial, visual
motor) - Memory function (auditory and visual)
- Graphmotor (pencil and paper) skills
- Attention/concentration
- executive functioning (reasoning, concept
formation)
21- Academic (Achievement) Testing
- reading
- reading comprehension
- written spelling
- arithmetic
22- Adaptive Functioning
-
- the performance of the daily activities
required for personal and social sufficiency - age related norms
- Defined by typical performance, not ability
23Vineland Adaptive Behaviour Scales
- 1. Communication Domain
- receptive language skills
- expressive language skills
- written language skills
- 2. Daily Living Skills Domain
- personal living skills
- domestic skills
- community living skills
24Vineland Adaptive Behaviour Scales
- 3. Socialization Skills Domain
- interpersonal relationships
- play and leisure time
- coping skills
- 4. Motor Skills (only up to age 6)
- gross motor skills
- fine motor skills
25Occupational Therapist
- Further assess fine motor, visual perceptual,
graphmotor skills - Explore sensory issues
26Speech and Language Pathologist
- Expressive/receptive language abilities
- Understanding of concepts
- Inferential and higher level language assessment
27Language Development in FASD
- Early expressive language delay
- May have articulation errors
- By kindergarten, expressive language may be
normal or near normal - Receptive skills may be normal or near normal on
VOCABULARY tests
28Language Development in FASD cont.
- Understanding of CONCEPTS is poor
- Non-literal language is not understood
- Poor abstract verbal reasoning
- Poor short term auditory memory makes
comprehension of stories difficult
29These subtle and often unnoticed language
deficits lead to
- Misunderstood instructions
- Difficulty remembering instructions
- Misinterpretation of verbal and social cues
- TROUBLE!!
30ADHD and FASD
- Attentional weakness, hyperactivity, impulsivity
definitely occur in FASD but these are not always
symptoms of isolated or primary ADHD - Other reasons for these symptoms must be explored
and supported - e.g. observe child's behavior during verbal and
non verbal activities is there a difference?
31ADHD and FASD cont.
- It is a myth that traditional medical therapies
dont work in FASD but they must be used in the
context of a complete assessment, diagnostic and
treatment process - It is very common for disruptive behaviour and/or
attentional weakness to be oversimplified as
representing ADHD
32Conclusions
- FASDs present in different ways at different ages
- Sometimes the presenting behaviour is reflective
of an underlying neurological problem that should
be assessed and supported - front line people (teachers, therapists, social
workers, counsellors, caregivers) need to be
aware of the varied presentations of FASD so that
appropriate assessment and diagnostic services
can be sought - Full assessment and diagnostic processes are
necessary to properly assess the subtle
neurological impairments, learning difficulties,
social and emotional challenges faced by children
affected by FASDs