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Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Fetal Alcohol Spectrum DisorderFetal Alcohol Spectrum Disorder
Dr. Brenda Stade, Mary Cunningham, Dr. Brenda Stade, Mary Cunningham,
Doug Nugent; St. Michael’s HospitalDoug Nugent; St. Michael’s Hospital
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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OutlineOutline IntroductionIntroduction Early Identification and AssessmentEarly Identification and Assessment
Diagnostic guidelines and assessmentDiagnostic guidelines and assessment Screening Screening Rational for early diagnosisRational for early diagnosis
Cognitive, Behavioral, Social Development and Cognitive, Behavioral, Social Development and Nutrition of Children, Birth to Age 6 yearsNutrition of Children, Birth to Age 6 years
Issues and StrategiesIssues and Strategies Focus on FamiliesFocus on Families
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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IntroductionIntroduction
In Canada the In Canada the incidence of Fetal incidence of Fetal Alcohol Spectrum Alcohol Spectrum Disorder (FASD) Disorder (FASD) has been has been estimated to be 1 estimated to be 1 in 100 live births.in 100 live births.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Introduction
Caused by prenatal exposure to Caused by prenatal exposure to alcohol.alcohol.
FASD is the leading cause of FASD is the leading cause of developmental and cognitive developmental and cognitive disabilities among Canadian disabilities among Canadian children. children.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Introduction: Fetal Alcohol Spectrum Disorder Defined
Growth RestrictionGrowth Restriction Facial AnomaliesFacial Anomalies CNS DysfunctionCNS Dysfunction Prenatal Alcohol Prenatal Alcohol
ExposureExposure
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Introduction
Cost of FASD annually to Canada Cost of FASD annually to Canada of those 1 to 21 years old, was of those 1 to 21 years old, was $344,208,000 (95% CI $344,208,000 (95% CI $311,664,000; $376,752,000).$311,664,000; $376,752,000).
(Stade, 2004).(Stade, 2004).
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Introduction: EtiologyIntroduction: Etiology
Alcohol readily crosses the placenta Alcohol readily crosses the placenta and results in similar levels in the and results in similar levels in the mother and fetus.mother and fetus.
Rate of elimination is slower in the Rate of elimination is slower in the fetus.fetus.
Most teratogenic effect during Most teratogenic effect during organogenesis and development of organogenesis and development of the nervous system.the nervous system.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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EtiologyEtiology When neuronal activity is abnormally When neuronal activity is abnormally
suppressed during the developmental suppressed during the developmental period, the timing and sequence of period, the timing and sequence of synaptic connections is disrupted, and synaptic connections is disrupted, and this causes nerve cells to receive an this causes nerve cells to receive an internal signal to commit suicide, a form internal signal to commit suicide, a form of cell death known as "apoptosis". of cell death known as "apoptosis".
Addiction BiologyAddiction Biology 2004 Jun;9(2):137-49 2004 Jun;9(2):137-49..
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EtiologyEtiology Teratogenesis is grossly dose related, although Teratogenesis is grossly dose related, although
the threshold dose is still unknown and related to the threshold dose is still unknown and related to maternal/fetal susceptibility.maternal/fetal susceptibility.
Risk to fetus greatest with more than 7 standard Risk to fetus greatest with more than 7 standard drinks per week (1 standard drink = 13.6 grams drinks per week (1 standard drink = 13.6 grams of absolute alcohol). of absolute alcohol).
Binge drinking of more than 5 ounces (142 Binge drinking of more than 5 ounces (142 grams) per occasion vs. 4 or more drinks per grams) per occasion vs. 4 or more drinks per occasion. occasion.
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Standard drinks = 0.5 oz Standard drinks = 0.5 oz alcoholalcohol
12 oz (341 mL) can of beer (5% alcohol)
12 oz (341 mL) bottle of cooler (5% alcohol)
5 oz (142 mL) glass of wine (12% alcohol)
1.5 oz (43 mL) distilled spirits (40% alcohol)
3 oz (85 mL) fortified wine e.g. sherry or port (18% alcohol )
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EtiologyEtiology
No safe time to drink during No safe time to drink during pregnancy.pregnancy.
No known safe amount.No known safe amount.
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Risk FactorsRisk Factors
Maternal Age and ParityMaternal Age and Parity Chronicity of AlcoholismChronicity of Alcoholism Socioeconomic StatusSocioeconomic Status Polydrug UsePolydrug Use EthnicityEthnicity Fetal Susceptibility.Fetal Susceptibility.
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Diagnostic GuidelinesDiagnostic Guidelines
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Important Features of Important Features of Diagnostic GuidelinesDiagnostic Guidelines
Minimize false negatives and false Minimize false negatives and false positivespositives
Precisely define diagnostic criteriaPrecisely define diagnostic criteria Consider genetic and family historiesConsider genetic and family histories Multidisciplinary approach.Multidisciplinary approach.
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Rational for Early DiagnosisRational for Early Diagnosis
Accurate and timely diagnosis is Accurate and timely diagnosis is essential: essential: to improve outcomes to improve outcomes decrease risk of secondary disabilitiesdecrease risk of secondary disabilities increase opportunities for preventionincrease opportunities for prevention ensure more accurate estimates of ensure more accurate estimates of
incidence and prevalence.incidence and prevalence.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Canadian Guidelines for Canadian Guidelines for DiagnosisDiagnosis
CMAJ, March 2005CMAJ, March 2005 The Diagnostic ProcessThe Diagnostic Process
Screening and referralScreening and referral Physical exam and differential diagnosisPhysical exam and differential diagnosis Neurobehavioural assessmentNeurobehavioural assessment Treatment and follow-upTreatment and follow-up
Team membersTeam members Program director/Co-ordinatorProgram director/Co-ordinator Physician (trained in diagnosis)Physician (trained in diagnosis) PsychologistPsychologist Social workerSocial worker OT, Speech, psychiatrist, geneticist, addiction worker, OT, Speech, psychiatrist, geneticist, addiction worker,
community support workers, teachers etc.community support workers, teachers etc.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Canadian Guidelines for Canadian Guidelines for DiagnosisDiagnosis
Physical ExamPhysical Exam General physical to rule out other disordersGeneral physical to rule out other disorders Growth (at or below 10Growth (at or below 10thth percentile) percentile) Facial features.Facial features.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Growth RestrictionGrowth Restriction
Growth restriction is demonstrated Growth restriction is demonstrated by height and weight at or below the by height and weight at or below the tenth (10th) percentile. tenth (10th) percentile.
Growth restriction may be apparent Growth restriction may be apparent prenatally and/or postnatally.prenatally and/or postnatally.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Diagnosis:Diagnosis:Growth RestrictionGrowth Restriction
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Facial FeaturesFacial Features
Short palpebral fissuresShort palpebral fissuresSmooth or flat philtrumSmooth or flat philtrumThin upper lip.Thin upper lip.
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Facial FeaturesFacial Features
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Facial FeaturesFacial Features
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Associated AnomaliesAssociated Anomalies
Cardiac anomalies Cardiac anomalies Joint and limb anomaliesJoint and limb anomalies Neurotubal defectsNeurotubal defects Anomalies of the urogenital system Anomalies of the urogenital system Hearing disordersHearing disorders Visual problemsVisual problems Severe dental malocclusions.Severe dental malocclusions.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Canadian Guidelines for Diagnosis
-Neuro-behavioural Assessment Domains to be assessed by psychologist or Domains to be assessed by psychologist or
team:team: Hard and soft neurological signsHard and soft neurological signs Brain structureBrain structure Cognition (IQ)Cognition (IQ) CommunicationCommunication Academic achievementAcademic achievement MemoryMemory Executive functioningExecutive functioning Attention deficit/hyperactivityAttention deficit/hyperactivity Adaptive behaviour, social skills, social Adaptive behaviour, social skills, social
communication.communication.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Early InfancyEarly Infancy
TremorsTremors Poor suckPoor suck Hypotonic/Hypertonic Hypotonic/Hypertonic IrritabilityIrritability Feeding problemsFeeding problems Developmental delay.Developmental delay.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Early ChildhoodEarly Childhood
Cognitive ProblemsCognitive Problems Motor IssuesMotor Issues Behavioral PresentationBehavioral Presentation Sensory DysfunctionSensory Dysfunction Speech DelaySpeech Delay HyperactivityHyperactivity Socialization Difficulties.Socialization Difficulties.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Canadian Guidelines for Canadian Guidelines for DiagnosisDiagnosis
Maternal Alcohol History in Maternal Alcohol History in PregnancyPregnancy
Key to establishing an accurate diagnosisKey to establishing an accurate diagnosis Require confirmation based on clinical Require confirmation based on clinical
records, self-report, reliable observation.records, self-report, reliable observation.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Classification of FASDClassification of FASD
1.1. Fetal Alcohol Syndrome (FAS)Fetal Alcohol Syndrome (FAS)
2.2. Partial Fetal Alcohol Syndrome (PFAS) Partial Fetal Alcohol Syndrome (PFAS) with confirmed maternal alcohol with confirmed maternal alcohol exposure exposure
3.3. Alcohol-Related Neuro-Developmental Alcohol-Related Neuro-Developmental Disorder (ARND) with confirmed maternal Disorder (ARND) with confirmed maternal alcohol exposure.alcohol exposure.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Diagnostic CriteriaDiagnostic Criteria
FASFAS Evidence of growth impairmentEvidence of growth impairment 3 facial anomalies3 facial anomalies 3 central nervous system domains impaired3 central nervous system domains impaired Confirmed or unconfirmed alcohol exposure.Confirmed or unconfirmed alcohol exposure.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Diagnostic CriteriaDiagnostic Criteria
Partial FASPartial FAS 2 facial anomalies2 facial anomalies 3 central nervous system domains impaired3 central nervous system domains impaired Confirmed alcohol exposure.Confirmed alcohol exposure.
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Diagnostic CriteriaDiagnostic Criteria
ARNDARND 3 central nervous system domains impaired3 central nervous system domains impaired Confirmed alcohol exposure.Confirmed alcohol exposure.
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ScreeningScreening
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Screening and Primary Care Screening and Primary Care ReferralReferral
Referral of individuals to FASD Referral of individuals to FASD diagnostic clinics:diagnostic clinics:
Evidence of prenatal exposure to alcohol (or Evidence of prenatal exposure to alcohol (or probable) with suspected or confirmed CNS probable) with suspected or confirmed CNS dysfunction ordysfunction or
Presence of 3 characteristic facial features Presence of 3 characteristic facial features with growth deficits with or without known with growth deficits with or without known prenatal alcohol exposure.prenatal alcohol exposure.
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ConclusionConclusion
Diagnosis requires a multi-disciplinary Diagnosis requires a multi-disciplinary approachapproach
Diagnosis is complex and guidelines are Diagnosis is complex and guidelines are well defined and cannot be a gestalt well defined and cannot be a gestalt approachapproach
Confirmed prenatal alcohol exposure is Confirmed prenatal alcohol exposure is required for a diagnosis of Partial FAS and required for a diagnosis of Partial FAS and ARNDARND
Screening does not equate to diagnosis.Screening does not equate to diagnosis.
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Cognitive, Behavioral, Social Cognitive, Behavioral, Social Development and Nutrition of Development and Nutrition of Children from Birth to Age 6 Children from Birth to Age 6
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CognitiveCognitive
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CognitionCognition
Attention problems and memory Attention problems and memory deficits often make learning deficits often make learning difficult in the young child.difficult in the young child.
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CognitionCognition
Infants and young children with FASD Infants and young children with FASD live with differing levels of cognitive live with differing levels of cognitive abilitiesabilities
All programs to develop cognitive All programs to develop cognitive abilities should be child specific.abilities should be child specific.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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CognitionCognition
How does the individual child with FASDHow does the individual child with FASD
learn?learn?
Some are primarily visual learners, some Some are primarily visual learners, some are tactile learners, some kinesthetic, and are tactile learners, some kinesthetic, and some learn best by listening.some learn best by listening.
(Mountford,A. The Golden Hoop of Life).(Mountford,A. The Golden Hoop of Life).
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Cognition: StrategiesCognition: Strategies
If a child learns best through music …If a child learns best through music …
If a child learns through body movement …If a child learns through body movement …
If a child learns best through listening …If a child learns best through listening …
If a child is a tactile learner …If a child is a tactile learner …
(Mountford, A. The Golden Hoop of Life).(Mountford, A. The Golden Hoop of Life).
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Cognition: StrategiesCognition: Strategies
May need to use short sentencesMay need to use short sentences Break down information and Break down information and
instructioninstruction Repetition, Repetition, RepetitionRepetition, Repetition, Repetition Teach one concept at a time.Teach one concept at a time.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Cognition: StrategiesCognition: Strategies
“ “ It took him four weeks at age four to It took him four weeks at age four to learn the colour red. We decided in learn the colour red. We decided in February he was going to learn his colours. February he was going to learn his colours. So everyday of the month I dressed him in So everyday of the month I dressed him in red. red. The teacher had to say ‘X you’re wearing a The teacher had to say ‘X you’re wearing a red shirt today. Show me your shirt. It’s red shirt today. Show me your shirt. It’s red’. ‘X you’re wearing red pants today’. red’. ‘X you’re wearing red pants today’. Something had to be red”.Something had to be red”.
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Cognition: StrategiesCognition: Strategies
Treasure hunts Problem-solving activities Visual-spatial games Story building Math skills: visual teaching.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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CognitionCognition
Impacting on the development of Impacting on the development of cognitive skills is the child’s ability to cognitive skills is the child’s ability to process his sensory world.process his sensory world.
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SensitivitySensitivity
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Sensory ProcessingSensory Processing
Many infants and young childrenwith FASD have difficulty processing and organizing sensory information they receive from their own bodies and the outside world.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Sensory Processing
Sensory processing is a developmental process
Takes place in the central nervous system
Involves ability to take in informationthrough the senses, organize it in our brains and use it to respond appropriately.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Sensory Processing
The brain must properly process information from the senses to develop: concentration organization learning ability specialization of each side of the body and
brain self-esteem self-control.
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Sensory ProcessingSensory Processing
How does sensory processing How does sensory processing abilities impact on day-to-day life of abilities impact on day-to-day life of a child with FASD?a child with FASD?
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Normal Sensory IntegrationNormal Sensory Integration
Schwab, D. (2001).
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Sensory Processing Sensory Processing DysfunctionDysfunction
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Sensory ProcessingSensory Processing HypersensitiveHypersensitive
Touch (Touch Processing)Touch (Touch Processing) Noise (Auditory ProcessingNoise (Auditory Processing Visual Input (Visual Processing).Visual Input (Visual Processing).
Dysfunction in Behavioural Outcomes Dysfunction in Behavioural Outcomes of Sensory Processing.of Sensory Processing.
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Sensory Processing StrategiesSensory Processing Strategies Place your child first or last in linePlace your child first or last in line Wash clothes a couple of times before Wash clothes a couple of times before
wearingwearing Use soft beddingUse soft bedding Remove tags from clothesRemove tags from clothes Avoid: Avoid:
ties under the chinties under the chin thick seams in clothingthick seams in clothing clothes that are scratchyclothes that are scratchy
Avoid tickling.Avoid tickling.
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Sensory Processing StrategiesSensory Processing Strategies
Weighted VestsWeighted Vests Deep MassageDeep Massage Bear HugsBear Hugs Activities using a number of muscles Activities using a number of muscles
groups.groups.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Sensory Processing StrategiesSensory Processing Strategies
Tone down the room’s effects on all Tone down the room’s effects on all sensessenses
Avoid decorated roomsAvoid decorated rooms Walls should be single colour and Walls should be single colour and
very palevery pale Avoid clutter.Avoid clutter.
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Sensory Processing StrategiesSensory Processing Strategies
Provide a place/space where the Provide a place/space where the child can have a “quiet place” to bechild can have a “quiet place” to be
Avoid crowds and places with many Avoid crowds and places with many people, lots of noise and high activity people, lots of noise and high activity levellevel
At daycare, preschool, and school At daycare, preschool, and school group activity should avoid large group activity should avoid large groups.groups.
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Sensory Processing StrategiesSensory Processing Strategies
Group play – use little matsGroup play – use little mats Recognize why a child may refuse to Recognize why a child may refuse to
participate in a gameparticipate in a game Occupational Therapy.Occupational Therapy.
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Sensory ProcessingSensory Processing
HyposensitiveHyposensitive PainPain Hot or ColdHot or Cold
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Strategies: HyposensitiveStrategies: Hyposensitive
SupervisionSupervision Avoid overdressing in summerAvoid overdressing in summer Ensure dressed adequately in winterEnsure dressed adequately in winter Ensure child monitored and receives Ensure child monitored and receives
adequate care when ill.adequate care when ill.
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BehavioursBehaviours
Behavioural and Emotional Behavioural and Emotional Responses may reflect the child’s Responses may reflect the child’s outcomes of sensory processing. outcomes of sensory processing.
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Behaviour: HyperactivityBehaviour: Hyperactivity
Due to the child’s sensory processing Due to the child’s sensory processing difficulties he or she may have a difficulties he or she may have a constant need for activity.constant need for activity.
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StrategiesStrategies
Fidget ItemsFidget Items Short periods of Short periods of
sitting stillsitting still HammockHammock Teaching during Teaching during
activityactivity Music.Music.
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Difficult BehavioursDifficult Behaviours
What is needed is a change in What is needed is a change in thinking from discipline to redirection thinking from discipline to redirection or re-teachingor re-teaching
Prevention – sensory strategies, Prevention – sensory strategies, transitioning.transitioning.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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StrategiesStrategies
Be firm but supportiveBe firm but supportive Choose one or two critical behaviors at a Choose one or two critical behaviors at a
time to work ontime to work on Ignore minor negative behaviourIgnore minor negative behaviour Keep the mood positive. Give five timesKeep the mood positive. Give five times
more praise to every one correction.more praise to every one correction. Identify warning signs re: “melt down”Identify warning signs re: “melt down” Teach child to self-monitor.Teach child to self-monitor.
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Difficult BehavioursDifficult Behaviours
Calming strategies:Calming strategies: Comfort cornerComfort corner Tents and cavesTents and caves Very short time outsVery short time outs Deep pressure.Deep pressure.
Dr. Brenda Stade et al, A WorkshoDr. Brenda Stade et al, A Workshop on FASD: Early Years Professiop on FASD: Early Years Professional Development Workshopnal Development Workshop
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Crying: InfancyCrying: Infancy
Crying is an infant’s way of Crying is an infant’s way of expressing his/her needs.expressing his/her needs.
Infants prenatally exposed to alcohol Infants prenatally exposed to alcohol may seem like they are crying may seem like they are crying constantly. constantly.
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Crying: InfancyCrying: Infancy
Avoid, if you can, letting a baby get Avoid, if you can, letting a baby get to a state of frantic crying. to a state of frantic crying.
Get to know strategies that work Get to know strategies that work best, and tell other caregivers how best, and tell other caregivers how the baby likes to be handled.the baby likes to be handled.
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Crying: InfancyCrying: Infancy
Wrap the infant snugly in a receiving Wrap the infant snugly in a receiving blanket – when not sleepingblanket – when not sleeping
Use a sootherUse a soother Bathing may settle some, quiet music may Bathing may settle some, quiet music may
help othershelp others Rocking the infant up and down rather Rocking the infant up and down rather
than back and forth has been found to be than back and forth has been found to be soothing for some infants.soothing for some infants.
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Crying: Young ChildCrying: Young Child
Crying is a method of communication Crying is a method of communication for all young childrenfor all young children
In the child with FASD be alert for:In the child with FASD be alert for: sensory overloadsensory overload inability to communicate inability to communicate mood problems.mood problems.
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Crying: Young ChildCrying: Young Child Modify environmentModify environment Ensure child can communicate needs Ensure child can communicate needs
– pictures, sign language– pictures, sign language Assessment by a mental health Assessment by a mental health
professional.professional.
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Health & IllnessHealth & Illness
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Health and IllnessHealth and Illness
Generally, FASD is not defined by Generally, FASD is not defined by associated physical disability or associated physical disability or illness.illness.
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Health & IllnessHealth & Illness
Some children with FASD are born with organ anomalies.
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Organ AnomaliesOrgan Anomalies
Cardiac anomalies Cardiac anomalies Joint and limb anomaliesJoint and limb anomalies Neurotubal defectsNeurotubal defects Anomalies of the urogenital system. Anomalies of the urogenital system. Hearing disordersHearing disorders Visual problemsVisual problems Severe dental malocclusions.Severe dental malocclusions.
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Health & IllnessHealth & Illness
Zhang and others (2005) Zhang and others (2005) demonstrate the adverse effects of demonstrate the adverse effects of alcohol on immune competence and alcohol on immune competence and the increased vulnerability of the increased vulnerability of ethanol-exposed offspring. ethanol-exposed offspring.
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Health & IllnessHealth & Illness
The infant should not be exposed to environmental irritants such as tobacco smoke
Protect the infant from exposure to viruses.
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Health & IllnessHealth & Illness
Young children with FASD are Young children with FASD are particularly prone to upper particularly prone to upper respiratory illnesses and ear respiratory illnesses and ear infectionsinfections
Monitoring and ensure treatment as Monitoring and ensure treatment as necessary.necessary.
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Health & IllnessHealth & Illness
Motor deficits are not uncommon in Motor deficits are not uncommon in infants and young children with infants and young children with FASD.FASD. Infant & Pre-school stimulation Infant & Pre-school stimulation
programsprograms Occupational Therapy.Occupational Therapy.
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SleepSleep
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Sleep DisturbancesSleep Disturbances
Sleep disturbances among Sleep disturbances among individuals with FASD are not individuals with FASD are not uncommon.uncommon.
Younger children often have trouble Younger children often have trouble falling asleep and waking.falling asleep and waking.
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Sleep DisturbancesSleep Disturbances
They may have trouble settling and They may have trouble settling and wake often throughout the night.wake often throughout the night.
Night terrors among individuals with Night terrors among individuals with FASD can continue throughout life.FASD can continue throughout life.
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Sleep StrategiesSleep Strategies
Establish rituals for saying good nightEstablish rituals for saying good night Start a calming bedtime routine an Start a calming bedtime routine an
hour before bedtimehour before bedtime A light snack before bed may be A light snack before bed may be
beneficial for some children.beneficial for some children.
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Sleep StrategiesSleep Strategies
Decrease sensory stimulation in the Decrease sensory stimulation in the bedroombedroom
White noise when the child is in bed White noise when the child is in bed may be calming to some but may be calming to some but distracting to othersdistracting to others
Night-lights help some young Night-lights help some young children but for some can lead to children but for some can lead to night terrors.night terrors.
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Sleep StrategiesSleep Strategies
Start young to promote the child Start young to promote the child sleeping in his or her own bedsleeping in his or her own bed
Melatonin may be beneficialMelatonin may be beneficial Childproof the house for night Childproof the house for night
wandererswanderers As much as possible wake the child in As much as possible wake the child in
the same predictable way every the same predictable way every morning.morning.
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NutritionNutrition
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Growth and FASGrowth and FAS
1.1. Substantial literature on the Substantial literature on the association between association between maternal alcohol maternal alcohol consumption during consumption during pregnancy and decreased pregnancy and decreased neonatal weight, length and neonatal weight, length and head circumference.head circumference.
2.2. Unsure of the effect of Unsure of the effect of alcohol on growth alcohol on growth parameters later on in life.parameters later on in life.
McFadyen, K. (2005)McFadyen, K. (2005)
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Studies: Growth and FASDStudies: Growth and FASD
1.1. Russell (1991) Russell (1991) Differences in head circumference and ht at 6 Differences in head circumference and ht at 6
yearsyears
2.2. Sampson (1994) Sampson (1994) No detectable differences from 8 mos to 14 No detectable differences from 8 mos to 14
yearsyears
3.3. Day (2002)Day (2002) 11stst trimester exposure predicted significant trimester exposure predicted significant
reductions in wt, HC, and lengthreductions in wt, HC, and length 22ndnd trimester exposure predicted significant trimester exposure predicted significant
reductions in wt and skinfold thickness.reductions in wt and skinfold thickness.
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Nutrition and FASDNutrition and FASD Infants and young children with Infants and young children with
FASD must have there growth FASD must have there growth followed regularlyfollowed regularly
Those with poor growth/growth Those with poor growth/growth restriction should be followed by restriction should be followed by a dieticiana dietician
Motor dysfunction resulting in Motor dysfunction resulting in poor suck and swallow requires poor suck and swallow requires OT interventionOT intervention
““Picky eaters” requires Picky eaters” requires patience, persistence, and patience, persistence, and imagination.imagination.
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Essential Fatty AcidsEssential Fatty Acids
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What we know….What we know….
1.1. Essential fatty acids (EFA) are Essential fatty acids (EFA) are necessary for the formation necessary for the formation of healthy cell membranes, of healthy cell membranes, proper development and proper development and function of the brain and function of the brain and nervous system -nervous system -
2.2. Omega 3 and Omega 6 fatty Omega 3 and Omega 6 fatty acids must be provided from acids must be provided from food as they cannot be food as they cannot be synthesized by the body.synthesized by the body.
McFadyen, K. (2005)McFadyen, K. (2005)
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ESSENTIAL FATTY ACIDS
OMEGA 3 FATTY ACIDS OMEGA 6 FATTY ACIDS
Green leafy vegetables, Green leafy vegetables, flax, flaxseed oil, canola flax, flaxseed oil, canola oil, walnuts, Brazil nuts, oil, walnuts, Brazil nuts, fish oil, fish, tofu, and fish oil, fish, tofu, and eggseggs
Vegetable oils Vegetable oils (soybean, safflower, (soybean, safflower, and corn oil), nuts and and corn oil), nuts and seedsseeds
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What we know continued…What we know continued…
Some evidence indicates that Some evidence indicates that
fatty acid deficiencies or imbalances fatty acid deficiencies or imbalances may contribute to the negative may contribute to the negative sequelae of some childhood sequelae of some childhood
neuro-developmental disorders.neuro-developmental disorders.
McFadyen, K. (2005)McFadyen, K. (2005)
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EFA SupplementationEFA Supplementation
1.1. There have been no studies to date There have been no studies to date looking at EFA supplementation and looking at EFA supplementation and children with FASD.children with FASD.
2.2. Some studies have demonstrated Some studies have demonstrated the benefits of EFA in children with the benefits of EFA in children with other neuro-developmental other neuro-developmental disorders – but other research have disorders – but other research have found no effect.found no effect.
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Thoughts…..Thoughts…..
1.1. Pregnancy stresses maternal EFA Pregnancy stresses maternal EFA status because the mother must status because the mother must supply fatty acids needed for fetal supply fatty acids needed for fetal and placental growth.and placental growth.
2.2. Alcohol can disturb placental Alcohol can disturb placental transport.transport.
3.3. Alcohol increases fatty acid Alcohol increases fatty acid catabolism – resulting in ???catabolism – resulting in ???
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What we do not know….What we do not know….
1.1. Whether supplementation of Whether supplementation of essential fatty acids may benefit in essential fatty acids may benefit in children with FASDchildren with FASD
2.2. Optimal dosage of fatty acidsOptimal dosage of fatty acids
3.3. Optimal composition (Omega 3 and Optimal composition (Omega 3 and Omega 6 fatty acids)Omega 6 fatty acids)
4.4. Dose – response relationshipDose – response relationship
5.5. Duration or treatment.Duration or treatment.
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In the End……In the End……
Encourage the young child with FASD Encourage the young child with FASD to eat a variety of foods from the to eat a variety of foods from the four food groups. four food groups.
To increase intake of EFA’s offer fish, To increase intake of EFA’s offer fish, eggs, nuts, seeds and use vegetable eggs, nuts, seeds and use vegetable oils.oils.
Monitor growth.Monitor growth.
McFadyen, K. (2005)McFadyen, K. (2005)
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Social Skills & FriendshipsSocial Skills & Friendships
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Social Skills and FriendshipsSocial Skills and Friendships
Social skill Social skill development should development should begin early for begin early for children with FASD.children with FASD.
Distractibility, Distractibility, aggressiveness and, aggressiveness and, and impulsivity can and impulsivity can interfere with social interfere with social development.development.
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Social Skills and FriendshipsSocial Skills and Friendships
Social skills programSocial skills program Practice, model, rehearse social skills.Practice, model, rehearse social skills.
Foster activities that the child likes Foster activities that the child likes and is good atand is good at
Brief activities in small groups.Brief activities in small groups.
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Social Skills and FriendshipsSocial Skills and Friendships
Invite other children to the home and Invite other children to the home and adapt the situation so it is fun for the adapt the situation so it is fun for the other childrenother children
Educate young children that they Educate young children that they may learn or respond to situations or may learn or respond to situations or stimuli somewhat differently than stimuli somewhat differently than others.others.
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CaregiversCaregivers
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Strategies for CaregiversStrategies for Caregivers
Keep remembering they are not Keep remembering they are not willfully trying to make you willfully trying to make you exhausted or crazyexhausted or crazy
Forgive yourself when you lose your Forgive yourself when you lose your tempertemper
Allow yourself to grieveAllow yourself to grieve Advocate for their needs Advocate for their needs
It will make you feel better about them It will make you feel better about them and yourself.and yourself.
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Strategies for CaregiversStrategies for Caregivers
Do something for yourself every Do something for yourself every dayday
Find someone you can talk toFind someone you can talk to Try to get in as many breaks as Try to get in as many breaks as
possible – friends, family, respitepossible – friends, family, respite Monitor yourself for signs of Monitor yourself for signs of
increased stress and depression.increased stress and depression.
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Thank-YouThank-You
Thank-you Thank-you for listening!for listening!