FASD in Context: Substance Abuse Treatment. Minnesota Organization on Fetal Alcohol Syndrome (MOFAS) Fetal Alcohol Spectrum Disorders (FASD)

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1 Minnesota Organization on Fetal Alcohol (MOFAS) Our mission is to eliminate disability caused by alcohol consumption during pregnancy and to improve the quality of life for those living with Fetal Alcohol Spectrum s throughout Minnesota. FASD in Context: Substance Abuse Treatment Objectives: Define Fetal Alcohol Spectrum s (FASD) Describe how Fetal Alcohol is diagnosed Explain the specific challenges for adults with FASD who are in treatment Provide techniques that can be used to modify treatment 2 Fetal Alcohol Spectrum s (FASD) Define FASD 4 The FASD Umbrella Fetal Alcohol Spectrum s Fetal Alcohol Spectrum Fetal Alcohol (FAS) Partial Fetal Alcohol (pfas) Alcohol-Related Birth Defects (ARBD) Alcohol-Related Neurodevelopmental (ARND) Fetal Alcohol Effects (FAE) (replaced by ARBD & ARND in 1996) 5 6

2 FASD Continued According to the SAMHSA FASD Center for Excellence 7 SAMHSA Fetal Alcohol Spectrum s Center for Excellence. What You Need To Know: Fetal Alcohol Spectrum s by the Numbers. DHHS Pub. No. (SMA) Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration Of all the substances of abuse (including cocaine, heroin, and marijuana), alcohol produces by far the most serious neurobehavioral effects in the fetus. - Institute of Medicine Report to Congress, 1996 SAMHSA Fetal Alcohol Spectrum s Center for Excellence. What You Need To Know: Effects of Alcohol on the Fetus. DHHS Pub. No. (SMA) Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration Effect Alcohol Marijuana Cocaine Heroin Meth Low Birth Weight * * * * Impaired Growth * * Facial Malformation * * Intellectual & Dev. Delays * * * Hyperactivity, inattention * * * * Sleeping Problems * * * * * Poor Feeding * * * Excessive Crying * * * * Higher risk of SIDS * * Organ Damage Birth Defects * * Respiratory problems * * * 9 10 Fetal Development Chart Alcohol & the Fetal Brain: 11 12

3 FASD and the Brain A B C A B C A. MRI of a 14-year-old control subject with a normal corpus callosum B. 2-year-old with FAS and a thin corpus callosum C. 14-year-old with FAS and agenesis (absence due to abnormal development) of the corpus callosum. Source: Mattson, S.N.; Jernigan, T.L.; and Riley, E.P MRI and prenatal alcohol exposure: Images provide insight into FAS. Alcohol Health & Research World 18(1): Common Misdiagnoses or Co-occurring Diagnoses of FASD Attention Deficit/Hyperactivity Bipolar Major Depressive Posttraumatic Stress Obsessive-Compulsive Generalized Anxiety Oppositional Defiant Conduct Alcohol Dependence Alcohol Abuse Mild, Moderate, or Severe Mental Retardation Antisocial Personality Borderline Personality 14 Diagnostic Criteria for FAS Diagnostic Criteria 16 Facial Features of FAS Smooth philtrum (groove between nose and upper lip) Small palpebral fissures (eye openings) Thin upper lip Ethnicity and Characteristic FAS Facial Features The facial features are only apparent in a very small number of individuals. Most people with FASD do not exhibit any facial features. (photo of John Kellerman, 17 Source: American Family Physician Vol. 72/No. 2 (July 15, 2005) 18

4 Benefits to FASD Diagnosis Relief and better self-awareness for the individual May help the individual qualify for services Improved understanding and communication between clients, clinicians, family members and more Reframing of expectations - realistic vs. unattainable Barriers to Adult Diagnosis Facial features and growth deficiencies are less obvious in adulthood Most clinics serve pediatric populations Is there a history of prenatal exposure? Maternal alcoholism? Takes some detective work * Intervene as if when that makes the most sense 19 Winter Alcohol Abuse as a Secondary Disability Specific Challenges for Clients with FASD Primary disabilities are those the child is born with. Secondary disabilities are those that develop as a result of failure to properly deal with the primary disabilities. A longitudinal study that examined secondary disabilities found that 35% of adults with FASD have problems with alcohol & other drugs Streissguth, The cognitive impairments of FASD can interfere with the ability to be successful with typical treatment approaches. Difficulty with treatment based on verbal receptive language skills Difficulty with treatment based on processing information outside of session Brain damage includes the following: Poor impulse control Difficulty connecting actions with consequences Easily over-stimulated Misses social cues How does this affect treatment? Relapse Doesn t learn from mistakes Group time less effective Ability to get along with others 23 24

5 Brain damage includes the following: Memory deficit Hyperactive, short attention span Unable to generalize concepts How does this affect treatment? Forgets rules, can t follow multi-step instructions Long therapy sessions unsuccessful Using refusal skills in multiple locations Generational Cycle In a sample of 30 females with FASD who had given birth, 57% no longer were caring for their children 40% reported drinking during pregnancy 17% of the children were diagnosed with FASD 13% of the children were suspected of having FASD Lack of foresight, poor impulse control and poor judgment often lead to unprepared life events Modify Expectations Techniques to Modify Treatment 28 Developmental Skills Timeline SKILL DEVELOPMENTAL AGE EQUIVALENT Actual age 18 yrs Expressive language 20 yrs Comprehension 6 yrs Money and time concepts 8yrs Emotional maturity 6 yrs Physical maturity 18 yrs Reading ability 16yrs Social Skills 7 yrs Living skills 11 yrs Don t Assume Lack of progress = lack of motivation Not following directions = noncompliant Lack of concentration = ambivalence Inability to recognize negative consequences = denial Ann Streissguth, (Alcohol Clin Exp Research, Vol. 22, No. 2, April 1998) 29 30

6 Modify the Environment Address the Stigma of FASD If they do have a FASD diagnosis... Be ready to help them identify and process their feelings Help them understand that they are not responsible for their disability Teach them about the challenges they have related to the prenatal exposure Transitioning out of treatment & ongoing support Over-plan for unstructured settings Hand deliver client, have a co-session with the old support person and the new support Find non-alcoholic leisure activities they can enjoy Provide an opportunity for alumni to gather periodically Visit places where they ll need to resist temptation: grocery stores, gas stations, sporting events 8 Essentials for Success 33 From 8 Magic Keys developed by Deb Evensen and Jan Lutke Professional Paradigm Shift From To Don t Try Harder Try Differently If you ve told a child a thousand times and he still does not understand, then it is not the child who is a slow learner. - Walter Barbee Diane Malbin, M.S.W. 35

7 Contact Information: MOFAS Phone:

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