Fetal Alcohol Spectrum Disorder: The Role of the Early Childhood Educator in Recognition - PowerPoint PPT Presentation

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Fetal Alcohol Spectrum Disorder: The Role of the Early Childhood Educator in Recognition

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Fetal Alcohol Spectrum Disorder: The Role of the Early Childhood Educator in Recognition Dr. Barbara Fitzgerald, MD, FRCP(C) Clinical Assistant Professor, UBC – PowerPoint PPT presentation

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Title: Fetal Alcohol Spectrum Disorder: The Role of the Early Childhood Educator in Recognition


1
Fetal 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

2
Things 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.

6
What is FAS?
  • FAS is characterized by
  • growth deficiency
  • characteristic facial features
  • and
  • neurodevelopmental difficulties
  • (secondary to prenatal brain damage)

7
Why make the diagnosis?
  • Prevention of secondary disabilities
  • Prevention of FAS
  • Greater understanding on part of caregiver/teacher

8
From Dr. Ann Streissguth, 1996
9
Protective Factors
  • diagnosis prior to age 6
  • stable home environment
  • coordinated early intervention for developmental
    disabilities

10
Protective 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

11
Triggers 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

12
Triggers 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

13
Triggers for AssessmentPreschoolers (cont...)
  • Sensory issues - easily over stimulated,
    bothered by noises, textures
  • Difficulty with transitions
  • Routine bound
  • Social skills immaturity

14
Triggers for AssessmentPreschoolers (cont...)
  • Learning
  • Inconsistent
  • Unable to generalize from one situation to
    another
  • Dont learn from mistakes
  • Better at visual skills than verbal

15
Behaviour 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

16
Triggers 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

17
Triggers 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

18
Triggers 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

19
The Assessment ProcessWhat to expect
  • Physician
  • Complete history of parental and teacher concerns
  • Physical exam especially growth, facial
    characteristics and neurological exam

20
The 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

23
Vineland 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

24
Vineland 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

25
Occupational Therapist
  • Further assess fine motor, visual perceptual,
    graphmotor skills
  • Explore sensory issues

26
Speech and Language Pathologist
  • Expressive/receptive language abilities
  • Understanding of concepts
  • Inferential and higher level language assessment

27
Language 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

28
Language 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

29
These subtle and often unnoticed language
deficits lead to
  • Misunderstood instructions
  • Difficulty remembering instructions
  • Misinterpretation of verbal and social cues
  • TROUBLE!!

30
ADHD 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?

31
ADHD 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

32
Conclusions
  • 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
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